Синдром низкого сердечного выброса в кардиохирургии

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Синдром низкого сердечного выброса - одно из самых грозных и часто встречающихся осложнений в кардиохирургии. Оно значительно повышает риск развития осложнений и летальности. Выявлено множество прогностических признаков возникновения данного синдрома, включая предоперационные и интраоперационные факторы риска, а также различные лабораторные предикторы. Патофизиологические механизмы развития синдрома низкого сердечного выброса ограничены не только систолической дисфункцией миокарда - его развитию могут также способствовать диастолическая дисфункция и клапанные нарушения. Существует широкий спектр методов гемодинамического мониторинга, каждый из которых имеет определенную инвазивность и достоверность. Целенаправленная гемодинамическая терапия должна основываться на наиболее информативных и точных техниках мониторинга, а ее задачей представляется поддержание баланса между доставкой и потреблением кислорода. Лечение синдрома низкого сердечного выброса позволяет обеспечить адекватную гемодинамическую поддержку, тем самым увеличивая доставку кислорода к тканям и предотвращая органную дисфункцию. Терапией первой линии, сразу после коррекции волемического статуса, является использование инотропных, вазопрессорных и вазодилатирующих препаратов, что способствует повышению сократимости и оптимизации преднагрузки и постнагрузки. В наиболее тяжелых случаях может возникнуть необходимость применения средств механической поддержки, таких как внутриаортальный баллонный контрпульсатор, устройства вспомогательного кровообращения и экстракорпоральная мембранная оксигенация.

Об авторах

Д. Н. Мерекин

ФГБУ «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Минздрава России

Автор, ответственный за переписку.
Email: dnmerekin@gmail.com

Ломиворотов Владимир Владимирович - доктор медицинских наук, профессор, член-корреспондент РАН, руководитель центра анестезиологии и реаниматологии, Researcher ID: L-7868-2014.

630057, Новосибирск, ул. Барьерная, 30/1

Россия

В. В. Ломиворотов

ФГБУ «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Минздрава России

Email: fake@neicon.ru
ORCID iD: 0000-0001-8591-6461

Ломиворотов Владимир Владимирович - доктор медицинских наук, профессор, член-корреспондент РАН, руководитель центра анестезиологии и реаниматологии, Researcher ID: L-7868-2014.

630057, Новосибирск, ул. Барьерная, 30/1

Россия

С. М. Ефремов

ФГБУ «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Минздрава России

Email: fake@neicon.ru
ORCID iD: 0000-0001-5581-9169

Ефремов Сергей Михайлович - доктор медицинских наук, врач анестезиолог-реаниматолог отделения реанимации и интенсивной терапии.

630057, Новосибирск, ул. Барьерная, 30/1

Россия

М. Ю. Киров

ФГБОУ ВО «Северный государственный медицинский университет» Минздрава России

Email: fake@neicon.ru
ORCID iD: 0000-0002-4375-3374

Киров Михаил Юрьевич - доктор медицинских наук, профессор, заведующий кафедрой анестезиологии и реаниматологии.

163000, Архангельск, Троицкий пр-т, 51

Россия

В. Н. Ломиворотов

ФГБУ «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Минздрава России

Email: fake@neicon.ru

Ломиворотов Владимир Николаевич - доктор медицинских наук, профессор учебного центра.

630057, Новосибирск, ул. Барьерная, 30/1

Россия

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