Changes of indices of the oxygen-transport state, depending on periodization of the ischemic cerebral stroke

Abstract

Objective. To elaborate a clinico-pathogenetic periodization of ischemic cerebral stroke, depending on changes of the oxygen-transport state indices in critically ill patents, suffering the ischemic cerebral stroke on background of conduction of complex intensive therapy.
 Materials and methods. Into the investigation 75 patients, suffering ischemic cerebral stroke, ageing 41 - 77 yrs, were included, in whom the indices of oxygen-transport state and severity of neurological symptoms on background of complex intensive therapy were studied. Depending on severity of neurologic symptoms, three similar groups of patients were formed (25 patients in every one), suffering mild, middle-severe and severe ischemic cerebral stroke, in which the disease severity was determined in accordance to the National Institute of Health Stroke Scale.
 Results. On background of the complex intensive therapy conduction the duration of the most acute period in mild ischemic stroke have constituted 3 days, in a middle-severe - 4 days, and in a severe one - 7 days. Tendency towards minimization of neurologic deficiency was noted, if parameters of central hemodynamics, the oxygen budget and the cognition level were stabilized during 2 days. Simultaneously the cardiac index values for all groups of patients have been situated in a range of (2.99 ± 0.20) l × min-1 × m-2, the oxygen delivery index have exceeded (509 ± 34) ml × min-1 × m-2. The restored level of neurological symptoms have not a tendency towards improvement or was stable during several days in accordance to data of the National Institute of Health Stroke Scale. The restored level of neurological symptoms had a tendency to improvement or staying during several days stable in accordance to indices of scales of National Institute of Health and Comas Glasgow, than a progressive staged improvement began.
 Conclusion. Normalization during 2 days of the oxygen-transport state indices without neurological symptoms progression constitutes a criterion of conclusion of the most acute period of the disease in patients, suffering mild, middle-severe and severe ischemic cerebral stroke. The restored due to intensive therapy during 48 h the oxygen-transport state without progressing of neurological symptoms in patients, suffering ischemic cerebral stroke, witnesses lowering of the cerebral tissue oedema and restoration of the autoregulation processes.