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PostSubject: clinical picture   clinical picture Icon_minitimeWed May 02, 2007 9:07 pm

Infuzionno-transfuzi Major Therapy is limited in scope to avoid yatrogennyh complications and worsening of human vital functions. In order to correct and restore gipovolemii onkoticheskogo pressure to a 100-200 mL of concentrated solutions of albumin (preferably 20%), not less than 500 ml frozen plasma. To normalize plasma osmolyarnosti introduce 500 ml 6% solution of BSE. Those therapy seen as a preparation for an isolated ultrafiltration. Ultrafiltration is a participatory ekstrakorporalnoy dehydrated and carried out on capillary dializatorah without turning dializata. The method is to filter water from the blood cells through a semi-permeable membrane as a result of increased resistance to current blood dializatore. Make geparinizatsiya only extracorporeal circuit, as total geparinizatsiya in this situation is fraught with serious development koagulopaticheskih violations. Preferably use drugs of low fractions heparin (fraksiparin, trombofob). Average gained leachate about 3500 mL, but can vary greatly depending on the starting gipergidratatsii and received effect (the emergence of consciousness, the normalization of AD and DVDs recovery rate diureza, reducing peripheral oedema). In the future, in order to restore metabolism and circulation in the brain using drugs memory stimulants (nootropil, piratsetam) of 200-400 mg / d intravenously. A major concern for obstetricians in the last decade is the increase in the frequency of atypical forms of severe toxaemia-fat gepatoza pregnant (OZHGB) and HELLP-sindroma involving high fatality. These forms, many authors prefer to be classified as pregnancy, oslozhnivshiysya liver failure. Under a different etiology and pathogenetic mechanisms can provide a general overview of the treatment of atypical forms of gestosis : 1. The intensive preoperative training. 2. Emergency abdominal delivery prevention massive krovopoteri in intra-and aftercare period. 3. Gepatoprotektornaya and substitution therapy in the aftercare period. 4. Massive antibiotikoprofilakt Ika surgical complications. However, it should be borne in mind kliniko-diagnostiches s Features and therapeutic aspects of each form. When HELLP-sindrome clear clinical picture and not the primary symptoms nespetsifichna. Usually this headache, increased fatigue, malaise. One of the main clinical signs are feeling gravity and pain in the right podrebere and epigastralnoy area. The neglected cases have vomiting content type "coffee thicker, and ikterichnost kozhno-gemorragichesko of syndrome. Sometimes HELLP-sindrom manifestiruet clinical picture of the total premature otsloyki normally situated placenta koagulopaticheskim with massive bleeding and rapid formation pechenochno-pochechnoy failure. The most informative for the diagnosis of this syndrome following lab indicators : Awareness transaminaz (AST> 200 U / L, ALT> 70 U / L), increased LDG more than 600 ED / l; Trombotsitopeniya (number plates less fans); Reduce antitrombina III below 70% and increasing its inactive form (complex AT-III- factor II); Vnutrisosudisty gemoliz. It should be borne in mind that thrombocytopenia, increased enzymes may take time to cause clinical symptoms and signs are often determined by random HELLP-sindrom is testimony to the urgent abdominalnomu rodorazresheniyu because the pathological process unpredictable. In addition, in connection with the development trombotsitopenii and the fetus is a fairly high risk of intracranial haemorrhage in giving birth through natural ancestral ways. Abdominal woman being held against the backdrop of a comprehensive intensive care.
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