РЕФЕРАТ ЦЕЛЬ. Определить частоту, стратифицировать тяжесть кардиохирургически-ассоциированного острого повреждения почек (КХА-ОПП) по прогностической системе RACHS в 6 категориях риска у новорожденных и грудных детей с врожденными пороками сердца (ВПС). ПАЦИЕНТЫ И МЕТОДЫ. В исследование включено 65 детей с ВПС до 1 года, из них 29(44,62%) новорожденных и 36(55,38%) от 1 месяца до 1 года, перенесших операцию. Диагноз ОПП установлен по AKIN-критериям (2007) с выделением 3-х стадий по уровню сывороточного креатинина (SCr). Тяжесть КХА-ОПП стратифицирована по прогностической системе RACHS в 6 категориях риска у новорожденных и грудных детей с ВПС. РЕЗУЛЬТАТЫ. Частота КХА-ОПП при ВПС у новорожденных в нашем исследовании составляет 72,1%, у грудных детей-41,67%. Статистически значимых различий в частоте КХА-ОПП у новорожденных при операциях с использованием и без использования ИК (р>0,05) не выявлено. У детей старше месяца и до 1 года выявлены статистически значимые различия в частоте ОПП в зависимости от использования искусственного кровообращения (p<0,001). В зависимости от категорий риска по RACHS частота ОПП составила 25% во 2-й категории, 28,57% в 3-й категории, 78,95% в 4-й и 91,67% в 6-й категории. В 3 категории риска КХА-ОПП встречается чаще у новорожденных (45,45%) чем у детей грудного возраста (10%) (р=0,049). Статистически значимых различий в развитии ОПП у новорожденных и детей грудного возраста в 4 и 6 категориях риска по RACHS не выявлено (p>0,05). Высокая частота развития ОПП в 4-6 категориях установлена как у новорожденных, так и у детей грудного возраста. ЗАКЛЮЧЕНИЕ. Высокая частота развития КХА-ОПП у новорожденных и детей грудного возраста с ВПС требует мультидисциплинарного подхода к диагностике и лечению в отделениях кардиореанимации. Распределение пациентов по категориям RACHS позволяет прогнозировать риск развития и тяжесть КХА-ОПП у новорожденных и грудных детей. Ключевые слова: кардиохирургически-ассоциированное острое повреждение почек, врожденные пороки сердца, система RACHS. ABSTRACT THE AIM. To determine frequency and severity of cardiac surgery-associated acute kidney injury (CSA-AKI) according to the predictive RACHS system of 6 risk categories in newborns and infants with CHD. PATIENTS AND METHODS. The study included 65 children under 1 year with CHD, 29 of them (44.62%) neonates and 36 newborns (55.38%) from 1 month to 1 year underwent surgery. The diagnosis of AKI was set up according to AKIN criteria (2007), with allocating 3 stages using the serum creatinine level (SCr). The severity of cardiac surgery associated AKI was distributed by categories of RACHS system of 6 risk categories in newborns and infants with CHD. RESULTS. 72,1% of neonates and 41,67% of infants developed cardiac surgeryassociated AKI. Statistically significant differences in the incidence of AKI in newborns operated on with or without cardiopulmonary bypass were not revealed. In infants from 1 month to 1 year there were differences in AKI frequency with regard to using bypass for surgical correction (p<0,001). Depe...
ПрогнозироВАние Вероятности рАзВития стернАльной инфекции у кАрдиохирургических ПАциентоВ 1 Кафедра сердечно-сосудистой хирургии (зав.-д-р мед. наук, проф., академик РАН Г. Г. Хубулава), Санкт-Петербургский государственный педиатрический медицинский университет МЗ РФ 2 1-я кафедра хирургии (усовершенствования врачей) им. П. А. Куприянова (зав.-д-р мед. наук, проф., академик РАН Г. Г. Хубулава), Военно-медицинская академия им. С. М. Кирова МО РФ, Санкт-Петербург Predicting the probability of the sternal wound infection in patients undergoing cardiac surgery
During open-heart surgery it is possible to disturbance of the barrier function and the appearance of inflammation in the systemic circulation of inflammatory mediators and pro-inflammatory cytokines, which is realized in the systemic inflammatory response syndrome (SIRS). To prevent the development of the condition, or to reduce the severity of its complications method of mechanical removal of inflammatory mediators and cytokines from the blood of the patient is the most efficient. At the moment, the problem of implementation of the systemic inflammatory response syndrome after surgery using cardiopulmonary bypass quite relevant because of the high frequency of its manifestations and adverse effects [18]. This explains the large number of studies aimed at both the study of the pathogenesis of systemic inflammatory response syndrome and the development of new methods to combat this phenomenon and the improvement of already applied methods and techniques [1, 4]. There are various ways to the reduction of the degree of systemic inflammatory response syndrome, but special attention is given to the study of methods of modified ultrafiltration and continuous veno-venous hemofiltration. Further study of the application of ultrafiltration on patients undergoing cardiac surgery heart surgery with the use of bypass is necessary for understanding of the physiology and pathophysiology of systemic inflammatory response syndrome induced by the conduct of bypass, as well as for the subsequent formulation of clinical guidelines for use in cardiac surgery practice. In this article we have tried to consider the most significant results of such studies.
Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with liver cirrhosis without preexisting cardiac disease. According to the definition established by the World Congress of Gasteroenterology in 2005, the diagnosis of CCM includes criteria reflecting systolic dysfunction, impaired diastolic relaxation, and electrophysiological disturbances. Because of minimal or even absent clinical symptoms and echocardiographic signs at rest according to the 2005 criteria, CCM diagnosis is often missed or delayed in most clinically stable cirrhotic patients. However, cardiac dysfunction progresses in time and contributes to the pathogenesis of hepatorenal syndrome and increased morbidity and mortality after liver transplantation, surgery, or other invasive procedures in cirrhotic patients. Therefore, a comprehensive cardiovascular assessment using newer techniques for echocardiographic evaluation of systolic and diastolic function, allowing the diagnosis of CCM in the early stage of subclinical cardiovascular dysfunction, should be included in the screening process of liver transplant candidates and patients with cirrhosis in general. The present review aims to summarize the most important pathophysiological aspects of CCM, the usefulness of contemporary cardiovascular imaging techniques and parameters in the diagnosis of CCM, the current therapeutic options, and the importance of early diagnosis of cardiovascular impairment in cirrhotic patients.
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