References

rmt

Общая реаниматология

General Reanimatology

1813-97792411-7110

FSBI "SRIGR" RAMS

10.15360/1813-9779-2011-5-57

rmt-269

Research Article

ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ

REVIEWS & SHORT COMMUNICATIONS

Профилактика кардиальных осложнений внесердечных операций

Differentiated Prevention of Cardiac Complications of Extracardiac Surgery

Корниенко

А. Н.

Korniyenko

A. N.

Добрушина

О. Р.

Dobrushina

O. R.

dobrushina@gmail.com

Зинина

Е. П.

Zinina

E. P.

2011

20102011

Том VII № 5 2011 г.

5757

2011

Корниенко А.Н., Добрушина О.Р., Зинина Е.П.

Korniyenko A.N., Dobrushina O.R., Zinina E.P.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.reanimatology.com/rmt/article/view/269

В связи со старением населения развитых стран в анестезиологической практике все чаще встречаются больные с сопутствующими сердечно-сосудистыми заболеваниями. Частота кардиальных осложнений внесердечных операций составляет 1,4% у больных старше 50 лет после плановых некардиальных операций и доходит до 26,6% у больных старше 85 лет после экстренных абдоминальных операций. В обзоре рассматриваются причины, методы прогнозирования и способы профилактики кардиальных осложнений внесердечных операций. Последние разделены на три категории: тип 1 — коронарные, вследствие несоответствия доставки и потребления кислорода; тип 2 — коронарные, вследствие разрыва атеросклеротической бляшки с последующим тромбозом коронарной артерии и тип 3 — усугубление сердечной недостаточности. Для прогнозирования осложнений различных типов необходимо обращать внимание на следующие признаки и назначать дополнительные исследования: тип 1 — функциональный класс стенокардии напряжения, стресс-пробы (стресс-эхокардиография с добутамином и др.), коронароангиография, уровень тропонина Т и I крови; тип 2 — признаки распространенного атеросклеротического процесса, уровень СРБ и других маркеров воспаления в крови; тип 3 — клинические признаки сердечной недостаточности, уровень натрийуретических пептидов в крови. Кроме того, для оценки сердечно-сосудистого риска возможно использование специальных шкал (Lee, Goldman, Detsky и др.). С целью профилактики осложнений используется широкий спектр методик: тип 1 — хирургическая реваскуля-ризация миокарда, назначение бета-адреноблокаторов, коррекция нарушений гемодинамики под контролем инвазив-ного мониторинга; тип 2 — назначение антиагрегантов и статинов; тип 3 — ограничение инфузионной нагрузки, введение левосимендана, коррекция нарушений гемодинамики под контролем инвазивного мониторинга. Ключевые слова: сердечно-сосудистые заболевания, сердечная недостаточность, ишемическая болезнь сердца, кардиальные осложе-ния, оценка риска операций.

Due to population aging in developed countries, there are increasingly more patients with cardiovascular comorbidities in anesthesiological care. The frequency of cardiac complications of extracardiac surgery is 1.4% in patients over age 50 years following elective noncardiac surgery and amounts to 26.6% in those aged over 85 years after emergency abdominal operations. The review considers the causes, methods for prediction and prevention of cardiac complications of extracardiac surgery. The latter were divided into 3 types: 1) coronary complications due to the inconsistency of oxygen delivery and consumption; 2) coronary ones due to atherosclerotic plaque rupture, followed by coronary artery thrombosis; 3) worsening heart failure. To predict different types of complications, one must focus attention on the following signs and, if needed, perform additional studies: 1) the functional class of exertional angina, stress tests (stress echocardiography using dobutamine or other agents), coronary angiography, and blood troponin T and I levels for Type 1; 2) the signs of the extent of the atherosclerotic process and the blood levels of C-reactive protein and other inflammatory markers for Type 2; 3) the clinical signs of heart failure and the blood levels of natriuretic peptides for Type 3. Special scales (developed by Lee, Goldman, Detsky, et al.) may be also used to assess cardiovascular risk. For prevention of the complications, one may use a wide range of procedures: surgical myocardial revascularization, use of beta-adrenoblockers, and correction of hemodynamic disorders under invasive monitoring for Type 1; prescription of antiaggregants and statins for Type 2; limitation of infusion load, administration of levosimendan, and correction of hemodynamic disorders under invasive monitoring for Type 3. Key words: cardiovascular diseases, heart failure, coronary heart disease, cardiac complications, surgical risk assessment.

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