rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2017-4-46-63rmt-1603Research ArticleКАРДИОПРОТЕКТОРЫCARDIOPROTECTORSДексмедетомидин как кардиопротектор в кардиохирургии (обзор)Dexmedetomidine as a Cardioprotector in Cardiac Surgery (Review)КозловИ. А.KozlovI. A.

129110, г. Москва, ул. Щепкина, д. 61/2

61/2, Shchepkin Str., Moscow 129110

iakozlov@mail.ruКлыпаТ. В.KlypaT. V.

115682, г. Москва, Ореховый бульвар, д. 28

28 Orekhoviy Av., Moscow 115682

АнтоновИ. О.AntonovI. O.

115682, г. Москва, Ореховый бульвар, д. 28

28 Orekhoviy Av., Moscow 115682

Московский областной научно-исследовательский клинический институт им. М. Ф. ВладимирскогоРоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian FederationФНКЦ Федерального медико-биологического агентства РоссииРоссияFederal Research and Clinical Center of Federal Medical and Biological agency of RussiaRussian Federation2017080920171344663Copyright © Козлов И.А., Клыпа Т.В., Антонов И.О., 20172017Козлов И.А., Клыпа Т.В., Антонов И.О.Kozlov I.A., Klypa T.V., Antonov I.O.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/1603

В данном обзоре литературы представили анализ публикаций, посвященных использованию селективного агониста α2-адренергических рецепторов (α2-АР) дексмедетомидина в качестве кардиопротектора при кардиохирургических операциях. Кратко изложили исторические аспекты внедрения агонистов α2-АР в практику анестезиологии-реаниматологии. Проанализировали возможные механизмы кардиопротекторного действия дексмедетомидина (центральный симпатолизиз, благоприятное влияние на для коронарного кровотока и уменьшение эффекта коронарного «обкрадывания» исходно ишемизированных зон миокарда, противовоспалительный и антиоксидантный эффект, предупреждение активации апоптоза). Проанализировали данные экспериментальных исследований, посвященных дексмедетомидиновой кардиопротекции. Рассмотрели результаты клинических исследований, включая данные мета-анализов. Изложили данные о благоприятном влиянии дексмедетомидина на различные показатели послеоперационного периода, включая снижение риска развития делирия, общие осложнения кардиохирургических вмешательств и летальность больных. Представили данные о кардиопротекторных свойствах дексмедетомидина у хирургических больных, которым выполняют некардиальные вмешательства, особенно сосудистые, включая операции высокого риска на аорте. Выполнили сравнительный анализ результатов клинических исследований, изучавших дексмедетомидиновую кардиопротекцию при операциях с искусственным кровообращением. Описали комплекс полезных фармакологических эффектов дексмедетомидина при анестезиолого-реаниматологическом обеспечении кардиохирургических операций, в том числе у больных пожилого и старческого возраста. Сделали вывод, что дексмедетомидиновая кардиопротекция в различных областях хирургии, несомненно, имеет хорошие перспективы.

The literature review presents an analysis of publications on the use of a selective α2-adrenergic receptor agonist (α2-AR) dexmedetomidine as a cardioprotector in cardiosurgical interventions. It summarizes historical aspects of the introduction of α2-AR agonists in the intensive care practice. It analyzes possible mechanisms of the cardioprotective effect of dexmedetomidine (central sympatholysis, favorable effects on the coronary circulation and relief of the coronary steal syndrome in originally ischemized areas of the myocardium, antiinflammatory and antioxidant effects, and prevention of apoptosis activation). Data from experimental studies of dexmedetomidine cardioprotection were analyzed. Results of clinical studies, including data of metanalyses, were discussed. It dwells on data on the favorable effect of dexmedetomidine on various parameters of the postoperative period, including a decreased risk of delirium, general complications of cardiosurgical interventions, and the mortality rate in patients. It presents data on cardioprotective properties of dexmedetomidine in surgical patients who undergo noncardiac interventions, particularly vascular ones, including high risk surgeries in the aorta. A comparative analysis of results of clinical trials studying the dexmedetomidine cardioprotection during surgeries with extracorporeal circulation was performed. A range of pharmacological effects of dexmedetomidine during anesthesiological support of cardiac surgeries, including those in elderly and senile patients, was described. It has been concluded that the dexmedetomidine cardioprotection in the various fields of surgery is obviously very promising.

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