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Оценка сердечно-сосудистого риска и профилактика осложнений при внесердечной хирургии у больных ишемической болезнью сердца

https://doi.org/10.18705/1607-419X-2020-26-6-629-639

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Аннотация

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.

Об авторах

А. В. Панов
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

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

Санкт-Петербург



Э. В. Кулешова
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

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

Санкт-Петербург



Н. Л. Лоховинина
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

Лоховинина Наталья Львовна — старший научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург



М. З. Алугишвили
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

Алугишвили Марианна Захариевна —научный сотрудник отдела ишемической болезни сердца

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



И. Т. Абесадзе
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

Абесадзе Инга Тенгизовна — научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург



И. В. Титенков
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

Титенков Игорь Викторович —научный сотрудник отдела ишемической болезни сердца

Санкт-Петербург



Ю. А. Кудаев
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской Федерации
Россия

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

Санкт-Петербург



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Панов А.В., Кулешова Э.В., Лоховинина Н.Л., Алугишвили М.З., Абесадзе И.Т., Титенков И.В., Кудаев Ю.А. Оценка сердечно-сосудистого риска и профилактика осложнений при внесердечной хирургии у больных ишемической болезнью сердца. Артериальная гипертензия. 2020;26(6):629-639. https://doi.org/10.18705/1607-419X-2020-26-6-629-639

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Panov A.V., Kuleshova E.V., Lokhovinina N.L., Alugishvili M.Z., Abesadze I.T., Titenkov I.V., Kudaev Yu.A. Assessment of cardiovascular risk and prevention of complications in non-cardiac surgery in patients with coronary heart disease. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2020;26(6):629-639. (In Russ.) https://doi.org/10.18705/1607-419X-2020-26-6-629-639

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ISSN 1607-419X (Print)
ISSN 2411-8524 (Online)