zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2025_2_30zabmedvestnik-410Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHЗначение таргетной коррекции волемического статуса в остром периоде у пациентов с ишемическим инсультом для раннего начала физической реабилитацииThe importance of targeted correction of volume status in the acute period in patients with ischemic stroke for the early start of physical rehabilitationhttps://orcid.org/0000-0003-4413-0897КулаковВ. В.KulakovV. V.

Владимир Владимирович Кулаков, врач-анестезиолог-реаниматолог

отделение реанимации и интенсивной терапии

121359; ул. Маршала Тимошенко, д. 15; Москва

Anesthesiologist and Emergency Physician

Reanimation and Intensive Care Department

121359; 15 Marshala Timoshenko St.; Moscow

vovanija@gmail.comhttps://orcid.org/0000-0003-1582-4152ГубайдуллинР. Р.GubaydullinR. R.

Ренат Рамилевич Губайдуллин, д. м. н., доцент, профессор

кафедра травматологии и ортопедии

121359;  ул. Маршала Тимошенко, д. 15; Москва

Doctor of Medical Sciences, Associate Professor, Professor

Department of Traumatology and Orthopedics

121359; 15 Marshala Timoshenko St.; Moscow

tempcor@list.ruФГБУ «Центральная клиническая больница с поликлиникой УД Президента РФ»РоссияCentral State Medical Academy of the Presidential Administration of the Russian FederationRussian Federation«Центральная государственная медицинская академия» Управления делами Президента РФРоссияCentral Clinical Hospital with a Polyclinic of the Presidential Administration of the Russian FederationRussian Federation202504072025023038Copyright © Кулаков В.В., Губайдуллин Р.Р., 20252025Кулаков В.В., Губайдуллин Р.Р.Kulakov V.V., Gubaydullin R.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/410   Цель

   Цель: оценить эффективность ранней таргетной инфузионной терапии у пациентов с ишемическим инсультом, в сочетании с высокобелковой нутритивной поддержкой с расчетом по уровню мочевины суточной мочи, в отношении сокращения сроков начала физической реабилитации.

   Материалы и методы

   Материалы и методы. В двух сопоставимых группах пациентов с ишемическим инсультом проводили коррекцию гиповолемии: в основной группе в дополнение к базисной инфузионной терапии применяли болюсное введение с ориентацией по системе FloTrac® и высокобелковое питание с расчетом по уровню мочевины суточной мочи; контрольная группа получала базисную инфузионную терапию согласно общепринятым подходам и питание без приоритета высоких показателей поступления белка. Оценивали сроки начала двигательной реабилитации с момента поступления и степень неврологического дефицита по шкале NIHSS при выписке из стационара.

   Результаты

   Результаты. В основной группе сеансы реабилитации начинались, в среднем, на сутки раньше, чем в контрольной группе; также в основной группе наблюдался более низкий балл по шкале NIHSS при выписке.

   Выводы

   Выводы. Таргетная коррекция гиповолемии с ориентацией на показатель прироста ударного объема сердца при проведении теста с пассивным поднятием ног (FloTrac®) позволяет раньше начать активную физическую реабилитацию и улучшает долгосрочный прогноз.

   Objective

   Objective. To evaluate the effectiveness of early targeted infusion therapy in patients with ischemic stroke, in combination with high-protein nutritional support calculated based on the level of urea in daily urine, in terms of reducing the time of onset of physical rehabilitation.

   Materials and methods

   Materials and methods. In two comparable groups of patients with ischemic stroke, hypovolemia was corrected: in the main group, in addition to basic infusion therapy, bolus administration with orientation according to the FloTrac® system and high-protein nutrition calculated based on the level of urea in daily urine were used; the control group received basic infusion therapy according to generally accepted approaches and nutrition without priority of high protein intake. The timing of the onset of motor rehabilitation from the moment of admission and the degree of neurological deficit according to the NIHSS scale at discharge from the hospital were assessed.

   Results

   Results. In the main group, rehabilitation sessions began, on average, one day earlier than in the control group; also, the main group had a lower NIHSS score at discharge.

   Conclusions

   Conclusions. Targeted correction of hypovolemia with a focus on the indicator of the increase in stroke volume during the passive leg raise test (FloTrac®) allows for earlier initiation of active physical rehabilitation and improves long-term prognosis.

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The authors declare that there are no conflicts of interest present.