Search

Aim: To evaluate the efficacy of the training method of rehabilitation of patients with neurogenic dysphagia in ischemic stroke carried out with the use of special nutrient mixtures as part of combination therapy., Material and Methods: The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients were treated with special binding compounds as part of a combination therapy. Thirty-five patients did not use the mixture. The dynamics of the recovery function of swallowing using PAS (the Penetration-Aspiration Scale) and FEDSS (the Fiberoptic Endoscopic Dysphagia Severity Scale), as well as the transition from tube to independent feeding were studied., Results and Conclusion: The training method of rehabilitation with the help of special nutritional mixtures allows achieving significantly better indicators of restoration of swallowing function assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia. This trend is most pronounced in the group of patients with pseudobulbar syndrome. The application of the training method leads to a significantly better transition from tube to independent feeding. Tracheal intubation and mechanical ventilation are an additional factor aggravating swallowing disorders.

Aim: To develop a practical algorithm for the correction of sodium levels and osmolality of blood plasma during the acute period of severe ischemic stroke (IS)., Material and Methods: One hundred and fifty patients with cardioembolic or atherothrombotic stroke, aged from 30 to 80 years, hospitalized in the first 12 h after symptom emergence, were examined. Neurological deficit was assessed with the NIHSS. The monitoring of blood plasma sodium level and osmolality of blood plasma in the 1st and 5th day after stroke as well as of blood circulation volume was performed. The level of antidiuretic hormone (ADH) was measured in patients with hyperosmolar syndrome with hypernatremia., Results and Conclusion: It has been shown that hyponatremia is not an independent predictor of outcome of IS, but requires a diagnostic search of the causes of this condition with subsequent correction of sodium levels. For hypernatremia therapeutic tactics varies depending on the timing of the beginning of IS. A conservative strategy for the correction of hypernatremia to plasma sodium blood levels of 150 mmol/L on the first day of IS and to 155 mg/dL since the third day can be used. If these values are exceeded, the most rapid correction of hypernatremia is necessary.

The Aim: to study and identify the impact of the osmolarity blood plasma level on outcomes atherothrombotic ischemic stroke, and cardioembolic subtype., Materials and Methods: The study included 150 patients with severe ischemic stroke pathogenesis of diferent subtypes. We studied the effect of the of the osmolarity bloodplasma level in the first dayfrom the disease beginning to ischemic stroke prognosis., Results: it is shown that the prognosisfor severe ischemic stroke pathogenesis of different subtypes of the first day disease is unfavorable to the level of blood plasma osmolality 297 mOsml. This cardioembolic ischemic strokes pathogenic subtypes are more severe course and worse prognosis., Conclusion: the osmolarity of blood plasma is an independent predictor of adverse outcome for ischemic stroke pathogenesis of different subtypes.

On the basis of the research on clinical and prognostic characteristics of the acute period of ischemic stroke, the author has created an algorithm of activities during the first 24 h of the disease. It allows to manage the relocation of the patient in a hospital and to carry out consultative, medical and preventive measures. A software package for optimization the process of decision taking in the management of these patients is suggested.

Basing on the results of the analysis of the main clinical-paraclinical syndromes of ischemic stroke in its acute period, two integrative analytic-prognostic systems have been designed. These systems improve quality of disease prognosis. More accurate prognosis is achieved by the model, which shows that outcome of ischemic stroke depends both on the initial condition of the disease and on its dynamics in the acutest period. The computerized system of early prognosis of ischemic stroke allows to give a detailed prognosis of complications and outcome of the disease. The use of the computerized system of early prognosis helps to gain the reliable improvement in groups of moderately severe and severe ischemic stroke.

Basing on the results of multiple classifications of 70 clinical, paraclinical and anamnestic signs of ischemic stroke with combined cardiac symptomatology, the models predicting clinical outcome in acute period of the disease and an original scale of numerical score have been worked out. It is mathematically proved that the severity of ischemic stroke with combined cardiac symptomatology, scoring 75 and above, inevitably results in progression of fatal outcome. A group of unfavorable clinical predictors was singled out. The periods with high rate of fatal outcome within exacerbation of ischemic stroke and pathogenic types of stroke were studied. It is first-ever shown that a role of cardiac and neurological symptoms in predicting fatal outcome depends on ischemic stroke severity. A relation between the probable fatal outcome and dynamics of severity of stroke with combined cardiac symptomatology within the first 3 days of the disease was also revealed for the first time.