rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2014-5-33-43rmt-1419Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSЕСТЬ ЛИ АНТИАРИТМИЧЕСКИЕ ЭФФЕКТЫ ОМЕГА3 ПОЛИНЕНАСЫЩЕННЫХ ЖИРНЫХ КИСЛОТ У КАРДИОХИРУРГИЧЕСКИХ БОЛЬНЫХ?Are There the Antiarrhythmic Effects of Omega3 Polyunsaturated Fatty Acids in Cardiosurgical Patients?ЛомиворотовВ. В.LomivorotovV. V.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

ЕфремовС. М.EfremovS. M.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

sergefremov@mail.ruПокушаловЕ. А.PokushalovE. A.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

РомановА. Б.RomanovA. B.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

ПономаревД. Н.PonomarevD. N.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

ЧернявскийА. М.ChernyavskyA. M.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

ШиловаА. Н.ShilovaA. N.

630055, г. Новосибирск, ул. Речкуновская, 15

15, Rechkunovskaya St., Novosibirsk 630055

Новосибирский научноисследовательский институт патологии кровообращения им. академика Е. Н. Мешалкина Минздрава РФ, Новосибирск, РоссияРоссияAcademician E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, RussiaRussian Federation2014211020141053343Copyright © Ломиворотов В.В., Ефремов С.М., Покушалов Е.А., Романов А.Б., Пономарев Д.Н., Чернявский А.М., Шилова А.Н., 20142014Ломиворотов В.В., Ефремов С.М., Покушалов Е.А., Романов А.Б., Пономарев Д.Н., Чернявский А.М., Шилова А.Н.Lomivorotov V.V., Efremov S.M., Pokushalov E.A., Romanov A.B., Ponomarev D.N., Chernyavsky A.M., Shilova A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1419Цель исследования

Цель исследования. Проверить гипотезу о том, что периоперационное использование омега3 полиненасыщенных жирных (О3 ПНЖК) кислот в виде внутривенной инфузии снизит риск возникновения послеоперационной фибрилляции предсердий (ПОФП) у пациентов ИБС, оперированных в условиях искусственного кровообращения (ИК).

Материалы и методы

Материалы и методы. Проспективное двойное слепое плацебо контролируемое исследование 39 пациентов. Пациенты были рандомизированы на 2 группы: (1) — 18 пациентам проводили инфузию О3 ПНЖК (Омегавен, Фрезениус Каби, Германия), начиная перед индукцией в анестезию в дозе 200 мг/кг/сут на протяжении первых суток и 100 мг/кг/сут со 2х по 7е сутки после операции. (2) — 21 пациент получали плацебо (Интралипид, Фрезениус Каби, Германия) в эквивалент ной дозе. Первичной конечной точкой была свобода от ПОФП на протяжении 2х лет после операции. ПОФП исследовали с использованием имплантируемого подкожно аппарата для длительного мониторирования сердечного ритма (Reveal XT, Medtronic, США). Опрос монитора проводили на 10е сутки, 3, 6, 12 и 24 месяц после операции.

Результаты

Результаты. ПОФП наблюдалась у 4х (19%) пациентов группы плацебо и 5 (27,8%) пациентов группы О3 ПНЖК на 10 сутки после операции (р=0,88). За 2 года наблюдения ПОФП выявлена у 5 (27,8%) пациентов группы контроля и у 6 (35,3%) пациентов группы О3 ПНЖК (р=0,9). Продолжительность ПОФП была ассоциирована с риском повторных госпитализаций вследствие декомпенсации сердечной недостаточности (коэффициент регрессии 0,24, стандартная ошибка 0,02, р<0,0001; R2=0,74).

Заключение

Заключение. Результаты проведенного исследования не подтверждают эффективности периоперационного использования О3 ПНЖК с целью профилактики ПОФП.

Objective

Objective: to test the hypothesis that the perioperative use of omega3 polyunsaturated fatty acids (ω3PUFA) as intravenous infusion will reduce the risk of postoperative atrial fibrillation (POAF) in patients with coronary heart disease operated on under extracorporeal circulation.

Subjects and methods

Subjects and methods. A doubleblind prospective controlled study was conducted in 39 patients who were randomized into two groups: 1) 18 patients were infused with ω3PUFA (Omegaven, Fresenius Kabi, Germany), beginning before inducing anesthesia in a dose of 200 mg/kg/day within the first 24 hours and 100 mg/kg/day on days 2 to 7 postsurgery; 2) 21 received placebo (Intralipid, Fresenius Kabi, Germany) in the equivalent dose. The primary end point was freedom from POAF during 2 months after surgery. POAF was examined using a subcutaneously implanted continuous cardiac rhythm monitoring device (Reveal XT, Medtronic, USA). Monitoring readings were taken on day 10 at 3, 6, 12, and 24 months following surgery.

Results

Results. POAF was observed in 4 (19%) patients in the placebo group and in 5 (27.8%) in the ω3PUFA group on days 10 postsurgery (p=0.88). During 2year followup, POAF was revealed in 5 (27.8%) patients in the control group and in 6 (35.3%) in the ω3PUFA group (p=0.9). The duration of POAF was associated with the risk of rehospitalizations for decompensated heart failure (regression coefficient, 0.24; standard error, 0.02; p<0.0001; R2=0.74).

Conclusion

Conclusion. The results of the study do not support the efficiency of perioperatively using ω3PUFA to prevent POAF

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