arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2020-26-6-629-639arthyper-2024Research ArticleСтатьиArticlesОценка сердечно-сосудистого риска и профилактика осложнений при внесердечной хирургии у больных ишемической болезнью сердцаAssessment of cardiovascular risk and prevention of complications in non-cardiac surgery in patients with coronary heart diseaseПановА. В.PanovA. V.

Панов Алексей Владимирович —доктор медицинских наук, профессор, главный научный сотрудник, руководитель отдела ишемической болезни сердца

Санкт-Петербург

Aleksey V. Panov, MD, PhD, DSc, Chief Researcher, Head, Department of Ischemic Heart Disease

St Petersburg

panov_av@almazovcentre.ruКулешоваЭ. В.KuleshovaE. V.

Кулешова Эльвира Владимировна —доктор медицинских наук, профессор, главный научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург

Elvira V. Kuleshova, MD, PhD, DSc, Chief Researcher, Department of Ischemic Heart Disease

St Petersburg

kuleshova_ev@almazovcentre.ruЛоховининаН. Л.LokhovininaN. L.

Лоховинина Наталья Львовна — старший научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург

Natalya L. Lokhovinina, MD, PhD, Senior Researcher, Department of Ischemic Heart Disease

St Petersburg

lokhovinina_nl@almazovcentre.ruАлугишвилиМ. З.AlugishviliM. Z.

Алугишвили Марианна Захариевна —научный сотрудник отдела ишемической болезни сердца

ул. Пархоменко, д.15, Санкт-Петербург, 194156

Marianna Z. Alugishvili, MD, PhD, Researcher, Department of Ischemic Heart Disease

15 Parkhomenko str., St Petersburg, 194156

alugishvili_mz@almazovcentre.ruАбесадзеИ. Т.AbesadzeI. T.

Абесадзе Инга Тенгизовна — научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург

Inga T. Abesadze, MD, PhD, Researcher, Department of Ischemic Heart Disease

St Petersburg

abesadze_it@almazovcentre.ruТитенковИ. В.TitenkovI. V.

Титенков Игорь Викторович —научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург

Igor V. Titenkov, Researcher, Department of Ischemic Heart Disease

St Petersburg

titenkov_iv@almazovcentre.ruКудаевЮ. А.KudaevYu. A.

Кудаев Юрий Анатольевич — врач-кардиолог отделения сердечно-сосудистой хирургии

Санкт-Петербург

Yuriy A. Kudaev, MD, Cardiologist, Department of Cardiosurgery

St Petersburg

kudaev_yua@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CenterRussian Federation202026112020266629639Copyright © Панов А.В., Кулешова Э.В., Лоховинина Н.Л., Алугишвили М.З., Абесадзе И.Т., Титенков И.В., Кудаев Ю.А., 20212021Панов А.В., Кулешова Э.В., Лоховинина Н.Л., Алугишвили М.З., Абесадзе И.Т., Титенков И.В., Кудаев Ю.А.Panov A.V., Kuleshova E.V., Lokhovinina N.L., Alugishvili M.Z., Abesadze I.T., Titenkov I.V., Kudaev Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2024

Частота развития сердечно-сосудистых осложнений при внесердечных операциях составляет около 3%. В обзоре представлены литературные данные относительно оценки сердечно-сосудистого риска (ССР) при внесердечных операциях. Рассматривается алгоритм принятия решений с учетом функционального состояния больного и категории ССР предстоящей операции. Функциональное тестирование не показано пациентам с низким ССР. Стресс-тесты следует рассматривать у больных высокого риска, если результаты тестирования могут изменить периоперационную медикаментозную терапию, способ анестезии или хирургический подход. Рутинная коронарная реваскуляризация не снижает периоперационные риски и применяется по специальным показаниям. Чрескожное коронарное вмешательство и связанная с ним двойная антиагрегантная терапия может задерживать сроки выполнения внесердечных операций. Периоперационная медикаментозная терапия (β-адреноблокаторы, аспирин, ингибиторы ангиотензинпревращающего фермента, блокаторы рецепторов к ангиотензину II и статины) должна назначаться с учетом специфического риска пациента.

The incidence of cardiovascular complications in non-cardiac surgery is about 3 %. The review presents the data on the assessment of cardiovascular risk (CVR) in non-cardiac surgery. The algorithm of decisionmaking considers the functional state of the patient and the category of CVR of the upcoming surgery. Functional testing is not indicated for patients with low CVR. Stress tests should be considered in high-risk patients if the test results may change the perioperative drug therapy, the method of anesthesia, or the surgical approach. Routine coronary revascularization does not reduce perioperative risks and is used for special indications. Percutaneous coronary intervention and associated dual antiplatelet therapy may delay the timing of non-cardiac operations. Perioperative drug therapy (beta-blockers, aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins) should be prescribed taking into account the individual risk of the patient.

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The authors declare that there are no conflicts of interest present.