Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева, г. Москва, Российская ФедерацияФибрилляция предсердий является наиболее частым осложнением хирургических вмешательств на открытом сердце, в том числе после операции аортокоронарного шунтирования, зачастую приводящим к значительному увеличению продолжительности пребывания в стационаре, ухудшающим течение раннего и среднесрочного послеоперационного периода и расширяющим объем экономических затрат на лечение.Целью представленной обзорной статьи является анализ литературных данных по фармакологическим и нефармакологическим подходам к лечению и профилактике развития фибрилляции предсердий в раннем послеоперационном периоде после аортокоронарного шунтирования. Несмотря на прогрессивное развитие фармакотерапии, а также на внедрение современных антиаритмических препаратов нового поколения, медикаментозные методы купирования послеоперационной фибрилляции предсердий не позволяют достичь должного результата, эффективность их не превышает 50-55%. Анализ литературы показал, что наиболее эффективным способом предупреждения и лечения данного нарушения ритма сердца является метод биатриальной сверхчастой стимуляции, проводимой в течение первых 72 часов после операции. Использование этой методики, по различным данным, позволяет достичь 75-85% свободы от фибрилляции предсердий в раннем послеоперационном периоде после аортокоронарного шунтирования, что статистически достоверно выше, чем при других (фармакологических и нефармакологических) методах профилактики и лечения. Кроме того, большинством авторов отмечается абсолютная безопасность использования биатриальной стимуляции в рутинной кардиохирургической практике.Ключевые слова: биатриальная стимуляция, фибрилляция предсердий, профилактика, аортокоронарное шунтирование, антиаритмические препараты, послеоперационный период Atrial fibrillation is the most frequent complication of the open heart surgery, including the coronary artery bypass grafting, often leading to a significant increase in the duration of hospital stay, worsening the course of the early and mid-term postoperative period and augmenting the economic costs of treatment.The aim of the present review is to analyze the data on pharmacological and non-pharmacological approaches to the treatment and prevention of atrial fibrillation in the early postoperative period after the coronary artery bypass grafting. Despite the progressive development of modern antiarrhythmic drugs, the success of sinus rhythm restoration in the postoperative atrial fibrillation does not exceed 50-55%. The literature analysis has shown that biatrial overdrive pacing for the first 72 hours after the surgery is the most effective method to prevent and manage this type of arrhythmia. According to the various studies, biatrial pacing allows achieving 75-85% freedom from atrial fibrillation in the early postoperative period following coronary artery bypass grafting, that is statistically higher than with any other (either pharmacological or non-pharmacologi...
Objective. Assessment of organizational and clinical aspects of acute coronary syndrome combined with a new coronavirus infection (SARS- CoV-2).Materials and methods. This is a retrospective study where 60 patients were divided into the following groups: group 1 patients with acute coronary syndrome (ACS) and a new coronavirus infection hospitalized in the «red» zone after infection was detected at the prehospital stage (n=29); group 2 - uninfected coronavirus infection patients with ACS (n=31). The primary points were mortality in the hospital and the average time (up to 2 months) after ACS, the incidence of acute heart failure, the incidence of ACS with ST segment elevation, the frequency of acute coronary artery occlusions.Results. The analysis of hospital mortality revealed its higher level in the ACS group and COVID-19 (group 1) (p=0.009). Mortality within 2 months was also higher in group 1 (p=0.017). The groups did not differ in the number of patients with ACS and ST segment elevation and acute coronary artery occlusions. Analysis of the incidence of OSN at admission revealed a statistically significant difference (p=0.05) in group 2 (n=12, 38.7%) compared with group 1 (n=5, 17.2%).Conclusions. Patients with ACS and COVID-19 are characterized by a higher initial severity, a tendency to develop ACS with ST segment elevation, high rates of hospital and 60-day mortality. Separating the flows of infected and uninfected patients makes it possible to improve the epidemiological situation in non-infectious hospitals, however, it leads to a delay in hospitalization of patients with ACS and COVID-19, which potentially increases the risk of fatal complications in this cohort.
Today, as a result of the reforms carried out in the field of currency policy liberalization in the Republic of Uzbekistan, a wide range of favorable opportunities is being created for entrepreneurs and citizens engaged in export-import operations.However, there are attempts to illegally use the opportunities created by some “impure entrepreneurs”and citizens, in particular, cases of currency smuggling. This situation, in turn, causes an escalation and growth of currency smuggling to the Republic of Uzbekistan.Since there is a need to prevent the problem of currency smuggling through effective research and analysis methods.Based on the above, this scientific article will cover in detail the scientific approaches to the study of the problem of currency smuggling and the analysis methods used
To date, there are cases of illegal export of values in electronic currency from the Republic of Uzbekistan to foreign countries, in particular, suchforeign currency as cryptocurrency, blockchain, mining. This situation, in turn, causes an escalation and an increase in the illegal withdrawal of electronic currency values from the Republic of Uzbekistan to foreign countries. Since the fight against theillegal export of currency values from the Republic of Uzbekistan to foreign countries remains an urgent task. Based on the foregoing, this scientific article will highlight in detail theimportance, prevention of illegal export of the Republic of Uzbekistan to foreign countries, illegal export of electronic currency values from the Republic of Uzbekistan to foreign countries establishment of administrative and criminal liability for embezzlement, legal regulation of relations related to electronic currency and relevance of the fight against illegal export of electronic currency values from the Republic of Uzbekistan to foreign countries, proposals on preventive measures
To date, there are known cases of illegal export of foreign currency from the Republic of Uzbekistanto foreign countries. The continuation of this negative trend will lead to an increase and increase in the smuggling of foreign currency from the Republic of Uzbekistan, as well as a violation of the monetary policy of Uzbekistan. Therefore, the fight against smuggling of foreign currency from the Republic of Uzbekistan to foreign countries remains an urgent task. Based on the foregoing, this scientific article describes in detail the proposals for preventing the illegal export of foreign currency from the Republic of Uzbekistan, for improving the organizational and legal basisof operational-search measures to combat illegal export of foreign currency from the Republic of Uzbekistan.Keywords: operational-search activity, operational-search activities, operational officer, operational analysis,currency, currency values, foreign economic activity, illegal export, cryptocurrency, foreign countries
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