Chronic heart failure (CHF) is a widespread disease associated with high rates of disability and mortality, as well as a decrease in the quality of life. Moreover, the vast majority of patients are elderly and senile. Modern surgical methods of treating heart failure are able to increase the duration and quality of life of such patients, however, the need far exceeds the volume of this care, and some highly effective methods common in Western countries are still not used in Russian clinical practice.
Elderly age is a risk factor for the development of senile asthenia (frailty) and concomitant pathology. Large abdominal surgery is often contraindicated for patients with signs of senile asthenia, and the method of choice in patients with severe heart failure is the implantation of devices for long-term mechanical circulatory support (LT-MCS). After implantation of LT-MCS, a regression of signs of senile asthenia may be observed.
The topic of an integrated approach to non-drug treatment of heart failure in elderly and senile patients in Russia has not been studied enough. In particular, the implantation of LT-MCS is not used in Russian clinical practice, while in many Western countries for many years it has been the main and most effective treatment for severe heart failure. Systematization of the available up-to-date information on this topic could help increase the duration and quality of life of patients with severe heart failure.
Введение.Синдром обструктивного апноэ во сне (СОАС) фактор риска развития фибрилляции предсердий (ФП). В свою очередь, ФП является наиболее частым послеоперационным осложнением коронарного шунтирования (КШ). Мы провели исследование возможной взаимосвязи СОАС и послеоперационных пароксизмов ФП, а также частоты возникновения данного осложнения у пациентов с СОАС, перенесших КШ. Материал и методы.У 32 кандидатов, которым была назначена операция КШ в плановом порядке, оценивали возраст, пол, индекс массы тела, клиническую картину, суточное кардиореспираторное мониторирование (КРМ), также оценивали показатели анализов крови и терапию. В послеоперационный период выполняли прикроватное электрокардиографическое мониторирование на предмет выявления пароксизмов ФП, оценивали сроки экстубации, выполняли повторное КРМ на 3-и сутки. Результаты.Пациенты были разделены на две группы: 1-я группа (СОАС-0) 17 пациентов с индексом апноэ/гипопноэ (ИАГ) менее 15 в час, 2-я группа (СОАС-1) 15 пациентов c ИАГ более 15 в час. У всех пациентов с исходными нарушениями дыхания во сне наблюдалось увеличение ИАГ после операции. Пароксизмы ФП возникли у 11 пациентов, а именно у 1 пациента из группы СОАС-0 и у 10 пациентов из группы СОАС-1 (р0,05). Заключение.У пациентов с ишемической болезнью сердца определяется высокая распространенность СОАС. Его выраженность значительно усиливается в послеоперационном периоде, а развитие послеоперационной ФП у пациентов после АКШ встречается чаще у пациентов с более тяжелым СОАС.
This review article examines the possibilities of surgical treatment of one of the socially significant diseases of modern society - arterial hypertension. The reasons for the development of parenchymal arterial hypertension have been disassembled. The reasons for the development of renovascular hypertension are discussed. Illuminates the pathogenesis of nephrogenic hypertension, statistical data on its prevalence. The issue of embolization of renal arteries in the treatment of nephrogenic arterial hypertension is considered. The forms of nephrogenic arterial hypertension in which the use of embolization is indicated. The etiology and pathogenesis of arterio-venous fistulas of the kidneys are described. Details of the world literature concerning the treatment of arterio-venous fistula and malformations of the kidneys are considered in detail. A review of literature data on materials used in embolisation of renal arteries in patients with arteriovenous fistula and malformations of the kidney is given. The etiology and pathogenesis of arterio-venous malformations of the kidneys are highlighted. The goal of embolization of the renal arteries in the preparation of patients with terminal renal failure and resistant arterial hypertension to kidney transplantation is described. The issue of preoperative preparation of patients before embolization of the renal arteries, the choice of operative access is considered. Methods of embolization of the renal arteries, possible complications and methods of their prevention are described. The data of the world literature concerning application of selective and superselective embolization of renal arteries in patients with parenchymal arterial hypertension are covered. The issue of potential use of renal artery embolization in other forms of nephrogenic arterial hypertension is also highlighted.
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