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Профилактика кардиальных осложнений внесердечных операций

https://doi.org/10.15360/1813-9779-2011-5-57

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Аннотация

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.

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Для цитирования:


Корниенко А.Н., Добрушина О.Р., Зинина Е.П. Профилактика кардиальных осложнений внесердечных операций . Общая реаниматология. 2011;7(5):57. https://doi.org/10.15360/1813-9779-2011-5-57

For citation:


Korniyenko A.N., Dobrushina O.R., Zinina E.P. Differentiated Prevention of Cardiac Complications of Extracardiac Surgery . General Reanimatology. 2011;7(5):57. (In Russ.) https://doi.org/10.15360/1813-9779-2011-5-57

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