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...
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.
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.
The diagnosis and treatment of patients with hemodynamic disorders is basing of the understanding the physiology and pathophysiology of cardiovascular system. The relationship between length of muscle fibers and power reduction were first time revealed by Fick. Otto Frank was formulated fundamental principles of contractility of cardiomyocytes. Straub and Wiggers in 1914 was described the mail principles of the right ventricle work. Ernest Starling was performed a series of experiments, which explore a dependence of left ventricular ejection from venous inflow and elastic resistance of the aorta. In 1914 Ernest Starling was published research result, which describe how the mechanical energy of heart beats is depend from length fiber. Another essential part of knowledge of this problem was discovered by Aurtur Guyton experiments. Guyton has been established that there is a linear relationship between the pressure in the right atrium and the venous return. The lack of quantitative assessment of volume status has led to a qualitative approach, de-scribed by the term “response to the volume load.” However, as pointed out by some authors [16, 29], it is important to remember that the response to the preload is not a pathological condition. A quantitative approach to the assessment of volume status is based on the concept of Guyton on average system pressure filling, theoretically independent of cardiac function. This approach is used clinically. In this review article we describe possibility of clinical application of all knowledge of this questions.
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