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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rmt</journal-id><journal-title-group><journal-title xml:lang="ru">Общая реаниматология</journal-title><trans-title-group xml:lang="en"><trans-title>General Reanimatology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1813-9779</issn><issn pub-type="epub">2411-7110</issn><publisher><publisher-name>FSBI "SRIGR" RAMS</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15360/1813-9779-2019-3-83-101</article-id><article-id custom-type="elpub" pub-id-type="custom">rmt-1777</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS &amp; SHORT COMMUNICATIONS</subject></subj-group></article-categories><title-group><article-title>Периоперационное повреждение миокарда  и сердечная недостаточностьв некардиальной хирургии (обзор). Часть 2. Снижение риска периоперационных кардиальных  осложнений с помощью фармакологических мер  и оптимизации анестезиолого-реаниматологического обеспечения</article-title><trans-title-group xml:lang="en"><trans-title>Perioperative Myocardial Damage and Heart Failure in Noncardiac Surgery. Part 2. Reduction of the Risk of Perioperative Cardiac Complications  by Pharmacological Measures and Optimization  of Anesthetic and Critical Care Support (Review)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Козлов</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kozlov</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>129110, г. Москва, ул. Щепкина, д. 61/2</p></bio><bio xml:lang="en"><p>61/2 Shchepkin Str., 129110 Moscow</p></bio><email xlink:type="simple">iakozlov@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Овезов</surname><given-names>А. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Ovezov</surname><given-names>A. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>129110, г. Москва, ул. Щепкина, д. 61/2</p></bio><bio xml:lang="en"><p>61/2 Shchepkin Str., 129110 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Петровская</surname><given-names>Э. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Petrovskaya</surname><given-names>E. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>129110, г. Москва, ул. Щепкина, д. 61/2</p></bio><bio xml:lang="en"><p>61/2 Shchepkin Str., 129110 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Московский областной научно-исследовательский клинический институт  им. М.Ф. Владимирского</institution><country>Россия</country></aff><aff xml:lang="en"><institution>M. F. Vladimirsky Moscow Regional Research Clinical Institute</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2019</year></pub-date><pub-date pub-type="epub"><day>07</day><month>07</month><year>2019</year></pub-date><volume>15</volume><issue>3</issue><fpage>83</fpage><lpage>101</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Козлов И.А., Овезов А.М., Петровская Э.Л., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder xml:lang="ru">Козлов И.А., Овезов А.М., Петровская Э.Л.</copyright-holder><copyright-holder xml:lang="en">Kozlov I.A., Ovezov A.M., Petrovskaya E.L.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.reanimatology.com/rmt/article/view/1777">https://www.reanimatology.com/rmt/article/view/1777</self-uri><abstract><p>Во второй части обзора литературы предоставили и проанализировали современные данные о методах адъювантной фармакологической кардиопротекции и возможностях оптимизации методов анестезиологического обеспечения и периоперационного мониторинга у больных высокого кардиального риска. Проанализировали изменения, внесенные в международные рекомендации за последние 2–3 года на основе доказательных исследований и мета-анализов. Проанализировали механизмы кардиопротекции и сведения об ее реализации в реальной клинической практике. Показали, что далеко не все рассматриваемые лекарственные средства могут широко использоваться с профилактической целью. Предоставили современные доказательные рекомендации по оптимизации анестезиологического обеспечения и периоперационного мониторинга. Сделали вывод, что практическая реализация комплексной стратегии, направленной на снижение риска кардиальных осложнений может обеспечить снижение как частоты тяжелых кардиальных осложнений, так и обусловленной ими летальности.</p></abstract><trans-abstract xml:lang="en"><p>The second part of the overview presents and analyzes the current data on the methods of adjuvant pharmacological cardioprotection and possibilities of optimizing the anesthetic support and perioperative monitoring in high cardiac risk patients. Amendments made in international guidelines for the last 2–3 years on the basis of conclusive studies and meta-analyses have been examined. Cardioprotection mechanisms and information about its implementation in real clinical practice have been analysed. It has been shown that by no means all drugs under discussion can be widely used for prophytlactic purposes. Contemporary evidencebased recommendations concerning the optimization of anesthetic support and perioperative monitoring are given. A conclusion has been made that practical implementation of a comprehensive strategy aimed at reduction of the risk of cardiac complications might ensure decrease of both the incidence of severe cardiac complications and mortality due to them.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>периоперационные кардиальные осложнения</kwd><kwd>некардиальные операции</kwd><kwd>фармакологическая кардиопротекция</kwd><kwd>механизмы кардиопротекции</kwd><kwd>профилактика ишемии миокарда</kwd><kwd>анестетическое прекондиционирование</kwd></kwd-group><kwd-group xml:lang="en"><kwd>perioperative cardiac complications</kwd><kwd>non-cardiac surgeries</kwd><kwd>pharmacological cardioprotection</kwd><kwd>cardioprotection mechanisms</kwd><kwd>myocardial ischemia prophylaxis</kwd><kwd>anesthetic preconditioning</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Thygesen K., Alpert J.S., Jaﬀe A.S., Chaitman B.R., Bax J.J., Morrow D.A., White H.D.; ESC Scientiﬁc Document Group. 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