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At present, cardiovascular disorders are the leading cause of death in the developed countries. In addition to the known risk factors associated with lifestyle or genetically determined, the evidence that in some cases the predisposition to cardiovascular diseases is formed even at the antenatal stage of life has appeared. The study implied the assessment of functional state of the right heart chambers in neonatal infants from the perinatal risk group in the neonatal period according to comprehensive evaluation of ultrasound findings of tissue myocardial Doppler imaging. A total of 285 newborns were examined: group 1 −− 108 healthy full−term newborns, group 2 −− 125 premature infants with a gestational age of 24−37 weeks, group 3 −− 52 infants with intrauterine growth retardation. In the early neonatal period, temporary systolic dysfunction of the right ventricle was detected in 26.9 % of children with intrauterine growth retardation and 23.2 % of premature infants, which occurs at the end of the first week of life. Tei index and fractional change in the area of the right ventricle are additional informative indices of systolic function of the right ventricle. The peculiarities of right ventricle diastolic function formation were determined in 85.6 % (p < 0.05) of premature infants; in the form of abnormal relaxation and in an undefined type in 8.0% of newborns; in 84.6 % (p < 0.05) of newborns with intrauterine growth retardation according in the form of abnormal relaxation and in 11.5 % in an undefined type. Follow−up examination showed normalization of the diastolic function in 3/4 of premature infants from the age of 5−6 months of the actual age, stabilization of the diastolic function in 1/3 of children by 6−8 months of the actual age. Employment of double Doppler technique provides important additional information on myocardial function of the right ventricle. The results of the study of the cardiovascular system of newborns from the perinatal risk groups show the importance of a long−term follow−up of development of such diseases in premature patients with intrauterine growth retardation, as well as the necessity of prospective studies of possible mechanisms that can trigger cardiovascular programming for the onset of the disease in the future.

Vessels are one of the main target organs affected by cardiovascular pathology. The definition of vascular age and, first of all, primary and/or secondary structural and functional changes affecting all of blood vessels is one of the main tasks of modern cardiology. It has been found that the large and medium vessels are more often affected. The following mechanisms of atherosclerosis development can be distinguished: genetic factors, dyslipidemia, risk factors that affect the vascular wall, and disorders of the receptor apparatus. The changes in the diameter of the vessel depend on the functional state of the endothelium; its dysfunction is a marker of the early stage of cardiovascular disease. Inflammation in the vascular wall, thickening of the intima and hypoxia lead to formation of an atherosclerotic plaque. The main group of drugs for treatment of dyslipidemia is statins, their efficacy has been proven in a number of large randomized studies. As a result of studying the role of the renin−angiotensin−aldosterone system in development of atherosclerosis, drugs affecting this mechanism, sartans, have been created. In addition to influencing the level of arterial pressure, they are able to change the structural and functional properties of various vessels. Monitoring of arterial stiffness against a background of pharmacotherapy is an essential component in the observation of the patients. Reduction of the pulse wave propagation rate and improvement of rigidity parameters testify to the favorable effect of therapy on the processes of vascular aging and prognosis of the disease, which is especially important in terms of the desire to achieve population results in reducing mortality from cardiovascular diseases.

Hypertensive crisis is a sudden significant increase of the blood pressure from a normal or elevated level, accompanied by the appearance or intensification of disorders in the target organs and characterized by deterioration of the cerebral/coronary/renal circulation or functioning of the autonomic nervous system. An uncomplicated hypertensive crisis is characterized by lack of clinical signs of acute or progressive disorders of target organs, however untimely medical aid to the patient can result in complications and death. Such crises are accompanied by appearance or intensification of symptoms from the target organs (intensive headache, pain in the heart, extrasystole) or the autonomic nervous system (vegetative vascular disorders, tremors, frequent urination). To provide an adequate medical aid for patients, the family doctor needs to know the main features of pharmacological correction of uncomplicated hypertensive crises. The main drugs with classes of antihypertensive drugs and time of their action are indicated. The categories of patients with prescribing preferences are listed. Attention is focused on the definition of the concepts of a complicated and uncomplicated hypertensive crisis, while classification criterion for hypertensive crisis is of importance for the tactics of BP reduction. The explanation is given for direct and potential threat to the life of the patient with the concept of rapid (within a few hours) and immediate (within minutes) reduction of blood pressure. Depending on the presence of side effects, absolute and relative contraindications, the list of the preferences for administration of inhibitors of angiotensin converting enzyme, beta−adrenoblockers, calcium antagonists is presented. Beta−adrenoblockers are effective in young patients with tachycardia syndrome and are unfavorable in cardiac blockade. Drugs of central action are preferable in patients with coronary artery disease. Calcium antagonists of short action should not be administered in persons with heart failure taking in account a negative inotropic effect. Sublingual administration of nifidipine increases the risk of cerebral and coronary ischemia. The considered rational, pathogenetically substantiated approaches to the administration of angiotensive drugs can help the family doctor to provide emergency medical aid in correcting uncomplicated hypertensive crisis in patients.

One of the features in clinical presentation of internal diseases is polymorbidity. The interaction of medical conditions significantly changes the prior disease progression, the severity and kind of the complications, worsens the life quality of the patient, restricts or complicates the diagnostic and treatment procedure. According to a number of authors, arterial hypertension (AH) is combined with broncho−obstructive diseases in 34.3 % of cases. Over the recent years, a significant increase was observed in the proportion of patients with combination of these diseases. The causes of the interaction of AH and bronchial asthma (BA) are complicated and are under investigation. The presence of low−intensity inflammation and oxygen deficiency in BA can accelerate development of AH, atherosclerotic vessel changes, left ventricular hypertrophy (LVH), involvement of right heart with the formation of chronic cor pulmonale and cardiac rhythm disturbances. In turn, a stable increase in systemic arterial pressure (AD) in BA contributes to the post−capillary pulmonary hypertension (PH), edema of interstitium and pneumonosclerosis with fixation of inconvertible components of bronchial obstruction. The literature data show that an increase in the heart rate (HR) and a tendency to heart consciousness is typical for the patients with BA. It was shown that increased heart rate is an independent mortality risk factor. At the present calcium channel blockers of the non−dihydropyridine series are the drugs of choice in patients with AH associated with BA, they have a dilatant effect on the vessels of the pulmonary circulation and have the properties of bronchodilators, decrease the heart rate. Modern thiazide−like diuretics can be effectively used in patients with combination of AH and BA. It is known that indapamide has a significant protective effect on target organs, it leads to LVH regression, has an angioprotective, direct vasodilator effect. Indapamide also has antioxidant properties and produces antisclerotic effects. At present great attention is paid to prevention of chronic heart failure (CHF) with a preserved left ventricular ejection fraction (LVEF). Treatment options that prevent heart remodeling in patients with a combination of BA and AH and therefore prevent the development of CHF with a preserved LVEF are actively studied. In general, the questionable situation in respect of treatment approaches in patients with associated cardiovascular and bronchopulmonary diseases is the basis for further study of this problem.

Acute pain is a symptom occurring immediately with tissue damage, limited to tissue repair time or smooth muscle dysfunction. In a number of cases, the pain regresses to tissues healing (cuts, bruises, abrasions). Those suffering from pain in the locomotor apparatus often become the patients of family doctors at the first stage, who make diagnosis and refer the patient to a specialist. However, the main task of the doctor is to alleviate the suffering of the patient. Therefore, administration of therapy at the first visit to the outpatient hospital should be carried out immediately, before receiving the data of the instrumental examination. From a practical perspective, if there is no suspicion or a serious spinal pathology is excluded, it is necessary to inform the patient about the favorable prognosis of the disease and the high probability of complete regression of the acute pain episode, since the acute pain syndrome is usually safely resolved with the help of conservative treatment. Before the beginning of the treatment it is necessary to determine the cause of the pain, duration and intensity, nature. Based on the pathophysiological aspects of pain and the mechanism of action of analgesics, the physician selects the drugs, prescribes adequate doses and adjusts them in such a way as to achieve anesthesia without side effects. Inadequate anesthesia leads to prolongation of the recovery period, increase in the cost of treatment, cardiovascular and other complications, chronic pathology and a decrease in the quality of life.

The purpose of this study was to investigate anthropometric and hemodynamic parameters in patients with essential hypertension, depending on the serum level of interleukin−22 (IL−22). The study involved 81 patients with hypertension who underwent detailed clinical, anthropometric, laboratory and instrumental examination. The diagnosis was verified using the criteria of the European Society of Hypertension (ESH) (2013). Abdominal obesity (AO) was diagnosed in patients with waist circumference over 102 cm for males and 88 cm for females, according to the guidelines of Association of Cardiologists of Ukraine (2012). IL−22 serum level was determined by enzyme immunoassay using Bender Medsystems® Human IL−22 Platinum ELISA kit. All patients were divided into tertiles by IL−22 serum fasting level. The level of IL−22 in the first tertile ranged from 20.23 pg/ml to 27.40 pg/ml; in the second one −− 27.49−31.51 pg/ml; in the third tertile the level of IL−22 was 31.61 −− 54,93 pg/ml. A comparative analysis of hemodynamic parameters (systolic blood pressure (SBP), diastolic blood pressure (DBP), pulsatile blood pressure (PBP)) was performed in patients with hypertension, depending on the level of IL−22, which demonstrated that SBP, DBP and PBP were significantly increased in parallel with an increase in the IL−22 serum level (p < 0.05). It was also found that the higher the level of IL−22 in the blood, the higher were the anthropometric indices such as body mass, body mass index (BMI), waist and hips circumference, waist to hips ratio, p < 0.05. A comparative intertertile analysis showed that the number of patients with AO increased together with an increase in Il−22 serum level. In conclusion, the obtained data, namely, a significant increase in BP values, in relation with an increase in the IL−22 serum level in hypertensive patients, may indicate involvement of the investigated cytokine in the pathogenesis of hypertension. In addition to it, our results suggest in favor of IL−22 significant role in development of obesity.

This article presents an effective, pathogenetically substantiated choice of volume of surgical treatment in patients with diseases of the common bile duct, complicated by mechanical jaundice, using preoperative complex prognosis of the risk of unsatisfactory consequences for each of the possible options for the volume of surgery and the selection of an optimal one. The present study allowed objectifying the choice of the volume of surgical treatment by creating an information model of the disease, which includes the most significant factors that determine it, and determining the optimal method of treatment based on this model. The developed information model included assessment of the patient's condition according to clinical, laboratory, X−ray, endoscopic, ultrasound, helical CT findings, determination of risk factors for complications, and selection of surgical intervention volume. As a risk factor for development of complications, the diagnosis on admission, the level of the biliary block, the duration of mechanical jaundice, the clinical diagnosis at the prehospital stage, the operational risk according to Gologorsky, the presence of cholangitis, the initial level of total serum bilirubin, ultrasound, endoscopy and CT scan were considered the risk factors of complications development. The optimal volume of surgical intervention is selected by providing risk factors for development of complications, ranked by the severity of the coefficients, calculation of the probability of income in a particular group (intervention option) for each of the options for intervention and the selection of the optimal variant by the maximum value of the calculated probability. The presented information model can be used to select an optimal method of surgical treatment for patients with diseases of the common bile duct, complicated obstructive jaundice, before the surgery thus reducing the number of complications and deaths. Decision−making tools allow taking into account previous experience (by comparing with a large database) and reduce the role of the subjective factor. As our practice shows, the information model is effective and pathogenetically substantiated.

Severity of somatic condition of the patients with obesity and complexity of surgical procedures determine the relevance of surgical−anesthetic risk objectification in bariatric surgery because accurate assessment of the perioperative risk allows to determine the optimal tactics and duration of the patient preparation for the surgery as well as effectively levels the risks of intraoperative and early postoperative complications, reduce the number of refusal to operate the patients. To improve the results of surgical treatment of morbid obese patients, the reliability of prediction of early postoperative complications and mortality using P−POSSUM was assessed in patients with morbid obesity, which underwent sleeve gastrectomy or biliopancreatic diversion with duodenal switch in Hess−Marceau modification. Subsequently, the predicted and the true number of early postoperative complications and lethality (during the first 30 days of the postoperative period) were compared using P−POSSUM. Non−parametric methods of statistical analysis (Mann−Whitney U−criterion) were used to assess the reliability of the relationship between the indicated events. The expected level of early postoperative complications in patients included in P−POSSUM study was 30.7±13.4 %. In fact, early postoperative complications occurred in 17 (8.3 %) patients. There were no fatal cases in the early postoperative period. The total correlation of actual to the predicted number of early complications of 0.27 and actual/predicted mortality of 0 showed a significant overassessment of their risk according to P−POSSUM. The results of the study indicate that the use of P−POSSUM in bariatric surgery leads to a significant overassessment of the risk of complications and mortality in the early postoperative period and may cause unwarranted failure of patients to undergo bariatric surgery.

Disorders of motor−evacuation function of the intestine are found not only after emergency, but also after planned and even small in volume abdominal interventions performed by laparoscopic access. Traditional operations in diseases of the colon tend to lead to prolonged intestinal paresis in the early postoperative period and development of a commissural disease due to trauma. Postoperative paresis should be considered at disorders of the evacuation of colon contents due to inhibition of the motor activity results in development of intestinal paresis and, as a consequence, the delay in the passage of intestinal contents, intensive growth and changes in the microflora of the small intestine. Under the conditions of the peritoneum inflammation, imbalance between different types of microorganisms and their distribution in different parts of the intestine develop. All these suggest of the necessity of measures to prevent intestinal paresis. The results of treatment of patients who underwent obstructive and reconstructive−reconstructive operations on the colon were analyzed to determine the efficacy of such measures. Some patients underwent traditional analgesic, infusion and prokinetic therapy during the operation and in the immediate postoperative period, while the others were administered benzohexonium at a dose of 0.12 mg/kg intravenously as a component of the neurovegetative blockade during the surgery (10−15 min after anesthesia) by means of tachyphylaxis, and 6 hours after the operation −− 0.12−0.15 mg/kg intramuscularly with narcotic and non−narcotic analgesics. The proposed program for prevention and treatment of gastrointestinal paresis after surgery on the colon can reduce the tone of the sympathetic nervous system, promote early recovery of digestive functions and prevents development of complications.

Recent studies have demonstrated that in patients with endometriosis the frequency of pregnancy is significantly lower than in healthy women. The association of endometriosis and infertility is well known, but the mechanisms of impaired fertility, approaches to treatment, analysis of the course of pregnancy, obtained with the help of assisted reproductive technologies in patients with this pathology, have not been fully investigated. In order to improve the differentiated tactics of infertility treatment in women with ovarian endometriosis, the course of pregnancy, depending on the method of assisted reproductive technologies and administration of vitamin D were investigated. Depending on the treatment method, the patients with endometriosis of the ovaries were divided into three groups: patients with extracorporeal fertilization performed after surgical treatment; women with controlled ovarian stimulation prior to surgical treatment of endometriomas and embryo transfer in the cryopreservation cycle was performed after endometriomyctomy; women with in vitro fertilization program, treated similarly to the second clinical group, but who were additionally administered vitamin D (cholecalciferol) 5000 IU/day. The effectiveness of the use of assisted reproductive technologies in women with endometriosis of the ovaries was also affected by the immune and endothelial status, the level of vitamin D, the time of in vitro fertilization (before or after surgery). These studies showed that infertility treatment in women with ovarian endometriosis with the use of assisted reproductive technologies before endometriomectomy against a background of vitamin D intake can significantly increase the effectiveness of in vitro fertilization and improve the course of subsequent pregnancy.

The relevance of the problem of thyroid diseases against a background of reproductive system disorders in women is associated with the growth of endocrine infertility due to thyropathies, especially of autoimmune origin. The study of the association between the reproductive system and the function of the thyroid gland can rationalize the approach in the timely diagnosis and treatment of patients with thyropathies. The analysis of specialized scientific literature was performed to generalize the data on the role of thyrotoxicosis and hypothyroidism in the development of endocrine infertility in women. The thyroid gland plays one of the key roles in the endocrine system and affects the growth and development, functional activity of all organs and systems. The prevalence and constant growth of thyroid diseases often causes irregularities in the menstrual cycle and can lead to infertility and prenatal loss in women. In the structure of thyroid disorders, autoimmune thyroiditis ranks second and is the most frequent cause of primary hypothyroidism. Autoimmune hypothyroidism leads to an imbalance of homeostasis, a slowdown in all metabolic processes in the body, a change in the rheological state of the blood, a disruption of the hypothalamic−pituitary−ovarian system. Women with thyrotoxicosis retain the ability to conceive, but this pathology plays a huge role in the gestation process and often leads to serious hemostasis disorders and miscarriage. The findings of the literature review suggest that timely diagnosis and treatment of thyroid disorders and inclusion of a test for thyroid hormones in the standards of therapeutic and diagnostic measures in women with infertility and miscarriage will reduce the risk of fetal loss and improve reproductive health.

The main method of infertility treatment is currently in vitro fertilization (IVF). In order to improve the effectiveness of IVF cycles, special attention has been paid to investigation of the state of the endometrium. The final stage in the diagnosis of the state of the endometrium is its morphological study. The aim of the present work was to study the morphological and histochemical changes in the endometrium in the donors on the fifth day after oocyte collection under different schemes of luteal phase (LF) support. On the day of the puncture, LF support began. On the 5th day after oocyte collection, the endometrium obtained with the biopsy was taken for morphological and histochemical study. In group 1, the endometrium obtained in the natural ovarian−menstrual cycle was studied; in group 2, for support of LF, the patients received dydrogesterone orally 30 mg per day; in group 3 −− highly purified progesterone for subcutaneous administration in combination with intravaginal progesterone gel (90 mg). Based on the comparative analysis of the morphological and histochemical state of the endometrium, it can be concluded that the most expressed readiness of the endometrium for blastocyst implantation is noted in patients of group 3, in whom the luteal phase of the ovarian−menstrual cycle was supported by highly purified progesterone for subcutaneous administration in combination with the intravaginal form of progesterone in the form of a gel (90 mg).

Cancer patients are characterized by changes in the system of anabolism−catabolism with a sharp increase in the need for energy donors and plastic material, increase in real energy demand and parallel development of the pathological tolerance of the organism to «normal nutrients». To study the characteristics of protein and carbohydrate metabolism in primary patients with locally advanced colorectal cancer, a study of carbohydrate and protein metabolism was conducted in 108 primary patients. The state of protein metabolism was studied using unified methods. When this syndrome is formed, there is a marked predominance of catabolic processes. Thus, carbohydrate metabolism is characterized by activation of gluconeogenesis in the liver. In this case, the main substrates are their own amino acids (alanine, glycine), formed during the decay of own somatic and visceral proteins. Disorders of protein metabolism are manifested by a pronounced predominance of protein breakdown (mobilization of own amino acids from somatic and visceral proteins) over its synthesis. In this case, active synthesis of proteins of the «acute phase» predominates in the liver. As a result, concentration of visceral proteins (albumin, transferrin) decreases rapidly. However, the total protein content may even increase due to the fraction of globulins. Thus, the study of protein−carbohydrate metabolism both in primary cancer patients and at different stages of combined treatment is an urgent task, the solution of which can contribute to increasing the effectiveness of the main methods of antiblastoma treatment. As a result of all these changes, protein−energy deficiency progresses, which contributes to organ dysfunction and decrease in the effectiveness of complex therapy.

To date, ovarian cancer is the most deadly gynecologic cancer. Early detection efforts and new therapeutic approaches to reducing mortality have not yielded meaningful results, perhaps because the origin and pathogenesis of epithelial ovarian cancer have been poorly studied. Studies have shown that epithelial ovarian cancer is not a single disease and consists of a diverse group of tumors that can be classified using their morphological and molecular genetic features. Ie−Ming Shih and Robert J. Kurman created a dualistic model in which all ovarian cancers were divided into two types. One group of tumors was called «low−grade» type. Highly differentiated serous, endometrioid, mucinous and light−celled cancers were attributed to it. These tumors, as a rule, are large and limited to the ovary, are prone to a slower course. The second group −− «high−grade» type −− includes tumors that have a high degree of aggressiveness and develop rapidly: low−grade serous carcinomas, undifferentiated carcinomas, malignant mixed mesodermal tumors (carcinosarcomas), some low−grade clear−celled ones. New data on the etiology and pathogenesis of ovarian cancer have not only a fundamental, but also an important clinical significance, since they allow formation of scientifically based risk groups.

Pediatric alopecia areata (AA) is a chronic inflammatory disease affecting the hair follicles. This is considered a tissue−specific autoimmune disease, mediated by autoactivated T−lymphocytes in conditions of disorders of immune tolerance of anagenic follicles. The genetic studies and analysis of expression of human genes showed significance of disorders of signal system JAK−STAT at AA development. Nowadays there is no universal method of treating AA, which would guarantee the absence of relapse in the future. Neither of the methods of treating AA has class A recommendations. The high level of spontaneous remission and insufficient amount of randomized double blind placebo−controlled studies makes evidence−based estimation of treatment methods difficult. The majority of evidence of effectiveness of the therapy in pediatric group of patients is extrapolated from the data of treating AA in adults and is characterized in even less level of reliability of the evidence base. When choosing the treatment tactic for children it is important to compare the risk level of prescribed medicine, the severity of the disease and expected therapeutic effect. At common pathologic process or at progressive course of the disease, it is important to discuss different ways of treatment with his/her parents. It is important to analyze the influence of the disease on the physical and emotional condition. Glucocorticosteroids, topical immunotherapy, dithranol, minoxidil, topical calcineurin inhibitors, psychotherapy, adjuvant therapy are used. The studies of effectiveness and safeness of oral and local inhibitors of JAK−kinase in pediatric AA are prospective.

The multifaceted pathogenesis of seborrheic dermatitis (SD) necessitates the study of various aspects of this dermatosis. Intestinal dysbacteriosis is a pathological process, an additional link in the pathogenesis of various dermatoses (atopic dermatitis, acne, microbial eczema, vitiligo). The data on intestinal dysbacteriosis at SD are solitary, therefore the goal of the study was to study the basic qualitative and quantitative parameters of the intestinal microflora in 42 patients, depending on the type, severity and duration of SD, determining the degree of dysbiotic disorders. Standard bacteriological method of stool examination was used to assess the state of the intestinal microflora. The study revealed a significant decrease in the number of obligate bacteria: bifido− and lactobacillus (p < 0.05), aerobic E. coli typical (p < 0.05), hemolytic E. coli in some patients, increase in the number of facultative (saprophytic epidermal staphylococcus) and conditionally pathogenic bacteria (yeast−like Candida fungi, enterobacter, cytrobacter, p < 0.05) as compared to those in the control group. Dysbacteriosis of the large intestine was established in 78.6 % of patients (grade 1 −− 36.4 %, grade 2 −− 45.5 % and grade 3 −− 18.1 %). The dependence of the degree of microbiological disturbances (dysbacteriosis) of the intestine and the degree of severity of dermatosis was revealed. In the inflammatory type of the disease, the quantity of not only bifidobacteria and lactobacilli significantly decreased in the patients (79.3 and 82.8 %), but also E. coli typical (89.7 %), which significantly differed from those in patients with non−inflammatory type of dermatosis (38.5, 30.8 and 23.1 %, p < 0.05). The amount of E. coli lactose−negative and E. coli hemolytic insignificantly increased in patients with inflammatory SD (10.4 and 20.0 %) compared with those in patients with another type of dermatosis (0 and 7.7 %, p < 0.05). Analysis of the qualitative composition of the large intestine microflora, depending on the duration of the disease, revealed reduction in the amount of indigenous microflora and increase in contamination by conventionally pathogenic microorganisms with an increase in the duration of dermatosis over five years. The study shows the relationship between the clinical features of SD and violations of intestinal microbiocenosis.

Age−related anatomical and functional changes in the elderly people affect the severity of the course of traumatic disease (TD) at polytrauma. To determine the efficacy and safety of nalbuphine for postoperative analgesia in geriatric patients with polytrauma we examined 31 patients over the age of 60 with the presence of skeletal polytrauma. All patients received as a postoperative analgesia with 10 mg nalbuphine. The study was conducted on the 1st, 3rd, 5th and 7th day after the operation. The level of pain was determined by the visual analog scale (VAS), the concentration of stress markers, the mediators of the systemic inflammatory response (SIR), and the parameters of the system of regulation of the aggregate blood state (RABS). The daily requirement for analgesics, the frequency of their administration, the side effects of the analgesia preparation, the duration of effective analgesia were taken into account. After 3 days of the postoperative period, there was a significant decrease in the need for anesthesia before its complete absence on day 7. Against a background of the administered doses of nalbuphine, its serious side effects, such as respiratory depression, were not observed. Nalbuphine reduced the intensity of stress reactions, without affecting at the same time the severity of SIR. During the first 5 days there was a tendency to hypercoagulation, the maximum was on the 1st day after the operation. At the end of the study, the level of soluble fibrin−monomer complex normalized in 38.7 % of patients and in 64.5 % −− antithrombin−III. Our results suggest that nalbuphine is not associated with the etiopathogenetic links of pain syndrome, but only with interruption of nociceptive impulses. However, nalbuphine does not cause such dangerous side effects as respiratory depression.

One of the main factors, producing a direct effect on the long−term outcome of the critical condition in patients with an elevated body mass index (BMI) at polytrauma, is the functional state of the vascular endothelium. To improve the effectiveness of critical state treatment in patients with elevated BMI and improve their quality of life after discharge a long−term complex clinical, instrumental and laboratory dynamic study of markers of endothelial dysfunction and apoptosis was conducted in 134 patients with elevated BMI with polytrauma with different ratings on the АРАСНЕ II scale at the time of admission within the time frame from 1 day to 180 days from the time of the injury. The effectiveness of the proposed intensive care complexes was evaluated in a prospective, randomized, open, cohort and comparative clinical trial in these patients. In patients with elevated BMI with polytrauma, endothelial dysfunction was prolonged to six months or more from the time of the injury; had a regular and unidirectional character, had periods of decline and rise in activity. The degree of damage, the consistency of compensatory capabilities and the ability to restore endothelial function in patients with elevated BMI with polytrauma depended on the type of infusion component of the intensive care complex. Infusion component of intensive therapy HES 200/0.5 6 % had the most pronounced endothelioprotective effect in monoadministration during the entire period of intensive care. To maintain endothelial function at the active level and slow the implementation of the apoptotic cascade, it is necessary to use a stepwise approach in the form of endothelioprotective agents when transferring a patient from an intensive care unit and later for a year after the injury.