НЕИНВАЗИВНАЯ ОЦЕНКА ГЕМОДИНАМИЧЕСКОГО СТАТУСА В КОМПЛЕКСЕ ПРЕДОПЕРАЦИОННОГО ОБСЛЕДОВАНИЯ БОЛЬНЫХ КОЛОРЕКТАЛЬНЫМ РАКОМ

Цель работы — определение возможностей неинвазивного исследования гемодинамического статуса больных колоректальным раком в рамках предоперационного анестезиологического обследования.

Материал и методы. В предоперационном периоде проведен анализ гемодинамического статуса у 97 пациентов с колоректальным раком (46 мужчин и 51 женщина). Средний возраст составил 67,59±9,48 лет. Интраоперационный риск по шкале POSSUM составил 20,20±3,2 балла. Оценка центральной гемодинамики (ЦГ) проводилась на предоперационном этапе всем пациентам с помощью «Комплекса мониторного кардиореспираторной системы и гидратации тканей компьютеризированного «Диамант» (Санкт-Петербург, Россия — регистрационное удостоверение ФСР No 2008/03201 от 22 августа 2008 г.).

Результаты. Неинвазивное исследование гемодинамического статуса позволяет дополнить предоперационное обследование больных колоректальным раком. У больных колоректальным раком в 43,3% случаев был диагностирован гиподинамический тип кровообращения, в 56,7% случаев — эудинамический. Не установлено существенного влияния возраста больных на их гемодинамический статус, что подтверждает целесообразность многофакторной оценки периоперационного риска.  

1. Goldzon M.A., Dolgikh V.T., Girsh A.O. Narushenie sistemnoi gemodinamiki, sokratimosti i metabolizma miokarda pri tyazheloi termicheskoi travme v eksperimente i ikh korrektsiya. Obshchaya Reanimatologiya. [Myocardial systemic hemodynamic, contractile, and metabolic impairments in severe thermal injury in the experiment and their correction. General Reanimatology]. 2012; 8 (3): 14—17. [In Russ.]

2. Krichevsky L.A., Rybakov V.Yu., Guseva O.G., Lyamin A.Yu., Kharlamova I.E., Magilevets A.I. Rannyaya diagnostika kriticheskikh postperfuzionnykh rasstroistv krovoobrashcheniya. Obshchaya Reanimatologiya. [Early diagnosis of critical postperfusion circulatory disorders. General Reanimatology]. 2012; 8 (3): 25—30. [In Russ.]

3. Lomivorotov V.V., Fominsky E.V., Nepomnyashchikh V.A., Efremov S.M., Chernyavsky A.M., Lomivorotov V.N., Shilova A.N., Karaskov A.M. Vliyanie rastvora khlorida natriya i gidroksietilkrakhmala (200/0.5) na funktsiyu legkikh i gemodinamiku bolnykh, operirovannykh s iskusstvennym krovoobrashcheniem. Obshchaya Reanimatologiya. [Effect of NaCl/hydroxyethyl starch 200/0.5 on lung function and hemodynamics in patients operated on under extracorporeal circulation. General Reanimatology]. 2012; 8 (5): 38—46. [In Russ.]

4. Stakanov A.V. Sistemnaya gemodinamika i splankhnichesky krovotok v usloviyakh predoperatsionnoi epiduralnoi analgezii na fone intraabdominalnoi gipertenzii pri ostroi tolstokishechnoi neprokhodimosti. Obshchaya Reanimatologiya. [Systemic hemodynamics and splanchnic blood flow under preoperative epidural analgesia in the presence of intraabdominal hypertension in acute colonic obstruction. General Reanimatology]. 2013; 9 (2): 39—44. [In Russ.]

5. Achkasov E.E., Melnikov P.V., Alekperov S.F., Kanner D.Yu. Evolyutsiya podkhodov k lecheniyu raka tolstoi kishki, oslozhnennogo tolstokishechnoi neprokhodimostyu. [Evolution of approaches to treating cancer of the large bowel complicated by its ileus]. Khirurg. 2012; 3: 54—62. [In Russ.]

6. Kirchhoff P., Clavien P.A., Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf. Surg. 2010; 4 (1): 5. http://dx.doi.org/10.1186/1754-9493-4-5. PMID: 20338045

7. Stakanov A.V., Ziborova L.N., Potseluev E.A., Musaeva T.S., Zabolotskikh I.B. Prognosticheskaya tsennost shkal u patsientov s razlichnym urovnem postoyannogo potentsiala pri ostroi tolstokishechnoi neprokhodimosti. Obshchaya Reanimatologiya. [Prognostic value of scales for patients with different level of constant potential in acute colonic ileus. General Reanimatology]. 2012; 8 (3): 36—41. [In Russ.]

8. Konishi T., Watanabe T., Kishimoto J., Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann. Surg. 2006; 244 (5): 758–763. http://dx.doi.org/10.1097/01.sla.0000219017.78611.49. PMID: 17060769

9. Alves A., Panis Y., Mantion G., Slim K., Kwiatkowski F., Vicaut E. The AFC score: validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1049 patients. Ann. Surg. 2007; 246 (1): 91–96. http://dx.doi.org/10.1097/SLA.0b013e3180602ff5. PMID: 17592296

10. Richards C.H., Leitch F.E., Horgan P.G., McMillan D.C. A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer. J. Gastrointest. Surg. 2010; 14 (10): 1511—1520. http://dx.doi.org/10.1007/s11605-010-1333-5. PMID: 20824372

11. Teeuwen P.H., Bremers A.J., Groenewoud J.M., van Laarhoven C.J., Bleichrodt R.P. Predictive value of POSSUM and ACPGBI scoring in mortality and morbidity of colorectal resection: a case-control study. J. Gastrointest. Surg. 2011; 15 (2): 294—303. http://dx.doi.org/10.1007/s11605-010-1354-0. PMID: 20936370

12. Parsons D.P. Preoperative evaluation and risk management. Clin. Colon. Rectal. Surg. 2009; 22 (1): 5—13. http://dx.doi.org/10.1055/s0029-1202870. PMID: 20119550

13. Kim S.H., Park S.Y., Cui J., Lee J.H., Cho S.H., Chae W.S., Jin H.C., Hwang K.H. Peripheral venous pressure as an alternative to central venous pressure in patients undergoing laparoscopic colorectal surgery. Br. J. Anaesth. 2011; 106 (3): 305—311. http://dx.doi.org/10.1093/bja/aeq399. PMID: 21258073

14. Kim E.J., Yoon H. The effects of pneumoperitoneum on heart rate, mean arterial blood pressure and cardiac output of hypertensive patients during laparoscopic colectomy. J. Korean Acad. Nurs. 2010; 40 (3): 433—441. http://dx.doi.org/10.4040/jkan.2010.40.3.433. PMID: 20634634

15. Neo J.H., Ager E.I., Angus P.W., Zhu J., Herath C.B., Christophi C. Changes in the renin angiotensin system during the development of colorectal cancer liver metastases. BMC Cancer. 2010; 10: 134. http://dx.doi.org/10.1186/1471-2407-10-134. PMID: 20380732

16. Messaris E., Sehgal R., Deiling S., Koltun W.A., Stewart D., McKenna K., Poritz L.S. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis. Colon. Rectum. 2012; 55 (2):175—180. http://dx.doi.org/10.1097/DCR.0b013e31823d0ec5. PMID: 22228161

17. Ringash J., Au H.J., Siu L.L., Shapiro J.D., Jonker D.J., Zalcberg J.R., Moore M.J., Strickland A., Kotb R., Jeffery M., Alcindor T., Ng S., Salim M., Sabesan S., Easaw J.C., Shannon J., El-Tahche F., Walters I., Tu D., O’Callaghan C.J.; NCIC Clinical Trials Group; Australasian Gastrointestinal Trials Group. Quality of life in patients with K-RAS wild-type colorectal cancer: the CO.20 phase 3 randomized trial. Cancer. 2014; 120 (2): 181—189. http://dx.doi.org/10.1002/cncr.28410. PMID: 24127364

18. Kosovskikh A.A., Kan S.L., Churlyaev Yu.A., Zoloeva O.S., Baranov A.A., Kruglyakov O.O. Funktsionalnoe sostoyanie mikrotsirkulyatsii kishechnika pri razlitom peritonite. Obshchaya Reanimatologiya. [The functional state of intestinal microcirculation in diffuse peritonitis. General Reanimatology]. 2012; 8 (2): 33—37. [In Russ.]

19. Barnes G.D., Alam S., Carter G., Pedersen C.M., Lee K.M., Hubbard T.J., Veitch S., Jeong H., White A., Cruden N.L., Huson L., Japp A.G., Newby D.E. Sustained cardiovascular actions of APJ agonism during reninangiotensin system activation and in patients with heart failure. Circ. Heart Fail. 2013; 6 (3): 482—491. http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.000077. PMID: 23519586

20. Hornero G., Díaz D., Casas O. Bioimpedance system for monitoring muscle and cardiovascular activity in the stump of lower-limb amputees. Physiol. Meas. 2013; 34 (2): 189—201. http://dx.doi.org/10.1088/0967-3334/34/2/189. PMID: 23348608

21. Malfatto G., Corticelli A., Villani A., Giglio A., Della Rosa F., Branzi G., Facchini M., Parati G. Transthoracic bioimpedance and brain natriuretic peptide assessment for prognostic stratification of outpatients with chronic systolic heart failure. Clin. Cardiol. 2013; 36 (2): 103—109. http://dx.doi.org/10.1002/clc.22086. PMID: 23377871

22. Ferreira J., Seoane F., Lindecrantz K. Portable bioimpedance monitor evaluation for continuous impedance measurements. Towards wearable plethysmography applications. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2013; 2013: 559—562. http://dx.doi.org/10.1109/EMBC.2013.6609561. PMID: 24109748

23. Vasilyev V.Yu. Znachenie monitoringa parametrov gemodinamiki pri provedenii intensivnoi infuzionnoi terapii. [The role of monitoring of hemodynamic parameters in intensive infusion therapy]. Meditsinskaya Tekhnika. 2005; 4: 54—56. PMID: 16144270. [In Russ.]

24. Su B.C., Yu H.P., Yang M.W., Lin C.C., Kao M.C., Chang C.H., Lee W.C. Reliability of a new ultrasonic cardiac output monitor in recipients of living donor liver transplantation. Liver Transpl. 2008; 14 (7): 1029— 1037. http://dx.doi.org/10.1002/lt.21461. PMID: 18581505

25. Taylor K., Manlhiot C., McCrindle B., Grosse-Wortmann L., Holtby H. Poor accuracy of noninvasive cardiac output monitoring using bioimpedance cardiography [PhysioFlow(R)] compared to magnetic resonance imaging in pediatric patients. Anesth. Analg. 2012; 114 (4): 771—775. http://dx.doi.org/10.1213/ANE.0b013e318246c32c. PMID: 22314693

26. Chong S.W., Peyton P.J. A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM). Anaesthesia. 2012; 67 (11): 1266—1271. http://dx.doi.org/10.1111/j.13652044.2012.07311.x. PMID: 22928650

27. Møller-Sørensen H., Hansen K.L., Østergaard M., Andersen L.W., Møller K. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution. Acta Anaesthesiol. Scand. 2012; 56 (4): 433—440. http://dx.doi.org/10.1111/j.1399-6576.2011.02615.x. PMID: 22191436

28. Vetchinkin A.V., Lebedinsky K.M., Kurapeyev I.S., Slivin O.A., Tsiklinsky S.A., Nikolaev A.V., Kobak A.E. Sravnenie rezultatov izmereniya serdechnogo vybrosa shestyu razlichnymi metodami do i posle ekstrakorporalnogo krovoobrashcheniya. [Comparison of cardiac output measurements by six different methods before and after extracorporeal circulation]. Anesteziologiya i Reanimatologiya. 2007; 5: 63—66. PMID: 18051496. [In Russ.]

29. Gracia J., Seppa V.P., Viik J., Hyttinen J. Multilead measurement system for the time-domain analysis of bioimpedance magnitude. IEEE Trans. Biomed. Eng. 2012; 59 (8): 2273—2280. http://dx.doi.org/10.1109/TBME.2012.2202318. PMID: 22692863

30. Chan C.P., Cheung P.L., Man Tse M., Agarwal N., Narain S., Chan S.S., Smith B.E., Graham C.A., Rainer T.H. Influence of different positions on hemodynamics derived from noninvasive transcutaneous Doppler ultrasound. Physiol. Rep. 2013; 1 (4): e00062. http://dx.doi.org/10.1002/phy2.62. PMID: 24303147

31. Kobelev A.V., Shchukin S.I. Tsifrovaya filtratsiya biosignalov na neskolkikh skorostyakh. [Digital biosignal filtring at several rates]. Biomeditsinskaya Radioelektronika. 2009; 10: 24—33. [In Russ.]

32. Kirpichenko Yu.E., Timokhin D.P., Shchukin S.I., Kudashov I.A., Tikhomirov A.N. Voprosy tochnosti opredeleniya parametrov deyatelnosti serdtsa na osnove tekhnologii vektornoi reokardiografii. [Problems in the vector rheocardiographic technology-based accurate determination of cardiac performance parameters]. Biomeditsinskaya Radioelektronika. 2012; 10: 4—7. [In Russ.]

33. Chashchin A.V., Popechitelev E.P. Analiz vliyaniya endogennykh faktorov na krovelimfonapolnenie v sosudistoi sisteme organizma. [Analysis of the influence of endogenous factors on blood and lymph filling in the vascular system of the body]. Sistemnyi Analiz i Upravlenie v Biomeditsinskikh Sistemakh. 2012; 11 (1): 26—38. [In Russ.]

34. Malyshev V.D. Anesteziologiya-Reanimatsiya – Intensivnaya Terapiya. [Anesthesiology-resuscitation — Intensive care]. Moscow: Meditsina Publishers; 2000: 98—103. [In Russ.]

35. Chissov V.I., Vashakmadze L.A., Sidorov D.V. Kolorektalnyi rak. V kn.: Chissov V.I., Daryalova S.L. (red.). Rukovodstvo po onkologii. [Colorectal cancer. In: Chissov V.I., Daryalova S.L. (eds.). A guide to oncology]. Moscow: Meditsinskoe Informatsionnoe Agentstvo; 2007: 495—517. [In Russ.]

36. Leung E., McArdle K., Wong L.S. Risk-adjusted scoring systems in colorectal surgery. Int. J. Surg. 2011; 9 (2): 130—135. http://dx.doi.org/10.1016/j.ijsu.2010.10.016. PMID: 21059414

37. Marchenko V.N., Trofimov V.I., Aleksandrin V.A., Fedoseyev G.B. Neirovegetativnaya regulyatsiya kardiorespiratornoi funktsionalnoi sistemy u bolnykh bronkhialnoi astmoi. [Neuroautonomic regulation of the cardiorespiratory functional system in asthmatic patients]. Vestnik Sovremennoi Klinicheskoi Meditsiny. 2010; 3 (3): 26а—29а. [In Russ.]

38. Nikolaev V.I., Denisenko N.P., Denisenko M.D. Tip krovoobrashcheniya i adaptatsiya (fiziologiya i psikhologiya). [The type of circulation and adaptation (physiology and psychology)]. Vestnik Rossiiskoi Voenno-Meditsinskoi Akademii. 2012; 2 (38): 70—73. [In Russ.]

39. Marik P.E., Cavallazzi R., Vasu T., Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Сrit. Care Med. 2009; 37 (9): 2642—2647. http://dx.doi.org/10.1097/ CCM. 0b013e3181a590da. PMID: 19602972

40. Marik P.E., Monnet X., Teboul J.L. Hemodynamic parameters to guidefluid therapy. Ann. Intensive Care. 2011; 1 (1): 1. http://dx.doi.org/ 10.1186/2110-5820-1-1. PMID: 21906322

41. Ransom D., Wilson K., Fournier M., Simes R.J., Gebski V., Yip D., Tebbutt N., Karapetis C.S., Ferry D., Gordon S., Price T.J. Final results of Australasian Gastrointestinal Trials Group ARCTIC study: an audit of raltitrexed for patients with cardiac toxicity induced by fluoropyrimidines. Ann. Oncol. 2014; 25 (1): 117—121. http://dx.doi.org/ 10.1093/annonc/mdt479. PMID: 24299960

42. Steger F., Hautmann M.G., Kölbl O. 5-FU-induced cardiac toxicity—an underestimated problem in radiooncology? Radiat. Oncol. 2012; 7: 212. http://dx.doi.org/10.1186/1748-717X-7-212. PMID: 23241239

43. Paiva C.E., Paiva B.S., Garita R., Michelin O.C., Okoshi K. Acute coronary syndrome associated with continuous 5-Fluorouracil infusion in a patient with metastatic colorectal cancera case report with a discussion on this clinical dilemma. J. Gastrointest. Cancer. 2009; 40 (3—4): 133—137. http://dx.doi.org/10.1007/s12029-009-9101-z. PMID: 19936641

44. Hernandez G., Regueira T., Bruhn A., Castro R., Rovegno M., Fuentealba A., Veas E., Berrutti D., Florez J., Kattan E., Martin C., Ince C. Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study. Ann. Intensive Care. 2012; 2 (1): 44. http://dx.doi.org/10.1186/2110-5820-2-44. PMID: 23067578