Профилактика кардиальных осложнений внесердечных операций
https://doi.org/10.15360/1813-9779-2011-5-57
Аннотация
В связи со старением населения развитых стран в анестезиологической практике все чаще встречаются больные с сопутствующими сердечно-сосудистыми заболеваниями. Частота кардиальных осложнений внесердечных операций составляет 1,4% у больных старше 50 лет после плановых некардиальных операций и доходит до 26,6% у больных старше 85 лет после экстренных абдоминальных операций. В обзоре рассматриваются причины, методы прогнозирования и способы профилактики кардиальных осложнений внесердечных операций. Последние разделены на три категории: тип 1 — коронарные, вследствие несоответствия доставки и потребления кислорода; тип 2 — коронарные, вследствие разрыва атеросклеротической бляшки с последующим тромбозом коронарной артерии и тип 3 — усугубление сердечной недостаточности. Для прогнозирования осложнений различных типов необходимо обращать внимание на следующие признаки и назначать дополнительные исследования: тип 1 — функциональный класс стенокардии напряжения, стресс-пробы (стресс-эхокардиография с добутамином и др.), коронароангиография, уровень тропонина Т и I крови; тип 2 — признаки распространенного атеросклеротического процесса, уровень СРБ и других маркеров воспаления в крови; тип 3 — клинические признаки сердечной недостаточности, уровень натрийуретических пептидов в крови. Кроме того, для оценки сердечно-сосудистого риска возможно использование специальных шкал (Lee, Goldman, Detsky и др.). С целью профилактики осложнений используется широкий спектр методик: тип 1 — хирургическая реваскуля-ризация миокарда, назначение бета-адреноблокаторов, коррекция нарушений гемодинамики под контролем инвазив-ного мониторинга; тип 2 — назначение антиагрегантов и статинов; тип 3 — ограничение инфузионной нагрузки, введение левосимендана, коррекция нарушений гемодинамики под контролем инвазивного мониторинга. Ключевые слова: сердечно-сосудистые заболевания, сердечная недостаточность, ишемическая болезнь сердца, кардиальные осложе-ния, оценка риска операций.
Список литературы
1. Медков В. М.
2. Lee T. H., Marcantonio E. R., Mangione C. M. et al.Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100 (10): 1043—1049.
3. Devereaux P. J., Goldman L., Cook D. J. et al.Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173 (6): 627—634.
4. Zerbib P., Kulick J. F., Lebuffe G. et al.Emergency major abdominal surgery in patients over 85 years of age. World J. Surg. 2005; 29 (7): 820—825.
5. Mangano D. T., Browner W. S., Hollenberg M. et al.Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N. Engl. J. Med. 1990; 323 (26): 1781—1788.
6. Ellis S. G., Hertzer N. R., YoungJ. R., Brener S.Angiographic correlates of cardiac death and myocardial infarction complicating major nontho-racic vascular surgery. Am. J. Cardiol. 1996; 77 (12): 1126—1128.
7. Cohen M. C., Aretz T. H.Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction. Cardiovasc. Pathol. 1999; 8 (3): 133—139.
8. Dawood M. M., Gutpa D. K., Southern J. et al.Pathology of fatal periop-erative myocardial infarction: implications regarding pathophysiology and prevention. Int. J. Cardiol. 1996; 57 (1): 37—44.
9. Landesberg G.The pathophysiology of perioperative myocardial infarction: facts and perspectives. J. Cardiothorac. Vasc. Anesth. 2003; 17 (1): 90—100.
10. Le Manach Y., Perel A., Coriat P. et al.Early and delayed myocardial infarction after abdominal aortic surgery. Anesthesiology 2005; 102 (5): 885—891.
11. Howard-Alpe G. M., Sear J. W., Foex P.Methods of detecting atherosclerosis in non-cardiac surgical patients; the role of biochemical markers. Br. J. Anaesth. 2006; 97 (6): 758—769.
12. Cruickshank A. M., Fraser W. D., Burns H. J. et al.Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin. Sci. (Lond). 1990; 79 (2): 161—165.
13. Scherer M. A., Neumaier M., von Gumppenberg S.C-reactive protein in patients who had operative fracture treatment. Clin. Orthop. Relat. Res. 2001; 18 (393): 287—293.
14. Baxevanis C. N., Papilas K., Dedoussis G. V. et al.Abnormal cytokine serum levels correlate with impaired cellular immune responses after surgery. Clin. Immunol. Immunopathol. 1994; 71 (1): 82—88.
15. Hammill B. G., Curtis L. H., Bennett-Guerrero E. et al.Impact of heart failure on patients undergoing major noncardiac surgery. Anesthesiology 2008; 108 (4): 559—567.
16. Goldman L., Caldera D. L., Nussbaum S. R. et al.Multifactorial index of cardiac risk in noncardiac surgical procedures. N. Engl. J. Med. 1977; 297 (16): 845—850.
17. Detsky A. S., Abrams H. B., McLaughlin J. R. et al.Predicting cardiac complications in patients undergoing non-cardiac surgery. J. Gen. Intern. Med. 1986; 1 (4): 211—219.
18. Arieff A. I.Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest 1999; 115 (5): 1371 — 1377.
19. Hernandez A. F., Newby L. K., O’Connor C. M.Preoperative evaluation for major noncardiac surgery: focusing on heart failure. Arch. Intern. Med. 2004; 164 (16): 1729—1736.
20. Lugo G., Arizpe D., Dominguez G. et al.Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients. Crit. Care Med. 1993; 21 (1): 64—69.
21. Taher T., Khan N. A., Devereaux P. J. et al.Assessment and reporting of perioperative cardiac risk by Canadian general internists: art or science? J. Gen. Intern. Med. 2002; 17 (12): 933—936.
22. Малышев Ю. П., Долмова К. А.Анестезиологическое обеспечение обширных онкологических операций у пациентов с заболеваниями сердечно-сосудистой системы. Онкохирургия 2008; 1: 78.
23. Хороненко В. Э.Операционно-анестезиологический риск и пути его снижения у гериатрического контингента больных с тяжелыми сопутствующими сердечно-сосудистыми заболеваниями: автореф. дисс… д.м.н. М., 2009.
24. Fleisher L. A., Beckman J. A., Brown K. A. et al.ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J. Am. Coll. Cardiol. 2007; 50 (17): 1707—1732.
25. Rohde L. E., Polanczyk C. A., Goldman L. et al.Usefulness of transtho-racic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am. J. Cardiol. 2001; 87 (5): 505—509.
26. Kertai M. D., Boersma E., BaxJ. J. et al.A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart 2003; 89 (11): 1327—1334.
27. Boersma E., Poldermans D., Bax J. J. et al.Predictors of cardiac events after major vascular surgery: Role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001; 285 (14): 1865—1873.
28. Balion C., Santaguida P. L., Hill S. et al.Testing for BNP and NT-proBNP in the diagnosis and prognosis of heart failure. Evid. Rep. Technol. Assess (Full Rep.). 2006; 142: 1—147.
29. Шалаев С. В., Волкова С. Ю.Прогностическое значение уровней в плазме N-концевого фрагмента мозгового натрийуретического пропептида и провоспалительных цитокинов у больных сердечной недостаточностью ишемической этиологии. Кардиология 2009; 49 (10): 22—26.
30. Manola S., Pavlovic N., Radeljic V. et al.B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocar-dial infarction, single-vessel disease, and complete revascularization: follow-up study. Croat. Med. J. 2009; 50 (5): 449—454.
31. Козлов И. А., Харламова И. Е.Повышенный уровень натрийуретиче-ского пептида В-типа (NT-proBNP) как фактор риска у кардиохи-рургических больных. Общая реаниматология 2010; VI (1): 49—55.
32. Мороз В. В., Никифоров Ю. В., Кричевский Л. А. и соавт.Значение сердечного пептида NT-proBNP в оценке риска реваскуляризации миокарда у больных со сниженной фракцией изгнания левого желудочка. Общая реаниматология 2010; VI (6): 38—42.
33. Eliasdottir S. B., Klemenzson G., Torfason B., Valsson F.Brain natriuretic peptide is a good predictor for outcome in cardiac surgery. Acta Anaesthesiol. Scand. 2008; 52 (2): 182—187.
34. Ray P., Delerme S.,Jourdain P., Chenevier-Gobeaux C.Differential diagnosis of acute dyspnea: the value of B natriuretic peptides in the emergency department. QJM 2008; 101 (11): 831—843.
35. Karthikeyan G., Moncur R. A., Levine O. et al.Is a pre-operative brain natri-uretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies. J. Am. Coll. Cardiol. 2009; 54 (17): 1599—1606.
36. Schutt R. C., Cevik C., Phy M. P.Plasma N-terminal prohormone brain natriuretic peptide as a marker for postoperative cardiac events in high-risk patients undergoing noncardiac surgery. Am. J. Cardiol. 2009; 104 (1): 137—140.
37. Yun K. H., Jeong M. H., Oh S. K. et al.Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and perioperative cardiovascular risk in elderly patients. Circ. J. 2008; 72 (2): 195—199.
38. Feringa H. H., Bax J. J., Elhendy A. et al.Association of plasma N-termi-nal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am. J. Cardiol. 2006; 98 (1): 111—115.
39. Grewal J, McKelvie R. S., Persson H. et al.Usefulness of N-terminal pro-brain natriuretic Peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction. Am. J. Cardiol. 2008; 102 (6): 733—737.
40. Choi J. H., Cho D. K., Song Y. B. et al.Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery. Heart 2010; 96 (1): 56—62.
41. Leibowitz D., Planer D., Rott D. et al.Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: a prospective study. Cardiology 2008; 110 (4): 266—270.
42. Шестопалова И. М.Стратегия диагностики и лечения ишемичес-кой болезни сердца в торако-абдоминальной онкохирургии: авто-реф. дисс… д.м.н. М., 2010.
43. Danesh J., Wheeler J. G., Hirschfield G. M. et al.C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N. Engl. J. Med. 2004; 350 (14): 1387—1397.
44. Cushman M., Arnold A. M., Psaty B. M. et al.C-reactive protein and the 10-year incidence of coronary heart disease in older men and women: the cardiovascular health study. Circulation 2005; 112 (1): 25—31.
45. Speidl W. S., Exner M., AmighiJ. et al.Complement component C5a predicts future cardiovascular events in patients with advanced atherosclerosis. Eur. Heart J. 2005; 26 (21): 2294—2299.
46. Johnson B. D., Kip K. E., Marroquin O. C. et al.Serum amyloid A as a predictor of coronary artery disease and cardiovascular outcome in women: the National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation 2004; 109 (6): 726—732.
47. Torzewski M., Rist C., Mortensen R. F. et al.C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arterioscler. Thromb Vasc. Biol. 2000; 20 (9): 2094—2099.
48. Vainas T., Stassen F. R. M., de Graaf R. et al.C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events. J. Vasc. Surg. 2005; 42 (2): 243—251.
49. Goei D, Hoeks S. E., Boersma E. et al.Incremental value of high-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide
50. for the prediction of postoperative cardiac events in noncardiac vascular surgery patients. Coron. Artery Dis. 2009; 20 (3): 219—224.
51. Feringa H. H., BaxJ.J., Schouten O., Poldermans D.Protecting the heart with cardiac medication in patients with left ventricular dysfunction undergoing major noncardiac vascular surgery. Semin. Cardiothorac. Vasc. Anesth. 2006; 10 (1): 25—31.
52. Mangano D. T., Layug E. L., Wallace A., Tateo I.Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N. Engl. J. Med. 1996; 335 (23): 1713—1720.
53. Poldermans D., Boersma E., Bax J. J. et al.The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N. Engl. J. Med. 1999; 341 (24): 1789—1794.
54. Devereaux P .J., Yang H., Yusuf S. et al.Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008; 371 (9627): 1839—1847.
55. Beattie W. S., Wijeysundera D. N., Karkouti K. et al.Acute surgical anemia influences the cardioprotective effects of beta-blockade: a single-center, propensity-matched cohort study. Anesthesiology 2010; 112 (1): 25—33.
56. Beving H., Zhao C., Albage A., Ivert T.Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul. Fibrinolysis 1996; 7 (1): 80—84.
57. Vial J. H., McLeod L. J., Roberts M. S.Rebound elevation in urinary thromboxane B2 and 6-keto-PGF1 alpha excretion after aspirin withdrawal. Adv. Prostaglandin Thromboxane Leukot. Res. 1991; 21A: 157—160.
58. Burger W., Chemnitius J. M., Kneissl G. D., Rucker G.Low-dose aspirin for secondary cardiovascular prevention — cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation — review and meta-analysis. J. Intern. Med. 2005; 257 (5): 399—414.
59. Chassot P. G., Delabays A., Spahn D. R.Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br. J. Anaesth. 2007; 99 (3): 316—328.
60. Dodds T. M., Stone J. G., Coromilas J. et al.Prophylactic nitroglycerin infusion during noncardiac surgery does not reduce perioperative ischemia. Anesth. Analg. 1993; 76 (4): 705-713.
61. O’Neil-Callahan K., Katsimaglis G., Tepper M. R. et al.Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J. Am. Coll. Cardiol. 2005; 45 (3): 336—342.
62. Feringa H. H., Schouten O., Karagiannis S. E. et al.Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery. J. Am. Coll. Cardiol. 2007; 50 (17): 1649—1656.
63. Katsaragakis S., Kapralou A., Markogiannakis H. et al.Preoperative lev-osimendan in heart failure patients undergoing noncardiac surgery. Neth. J. Med. 2008; 66 (4): 154—159.
64. Ponschab M., Hochmair N., Ghazwinian N. et al.Levosimendan infusion improves haemodynamics in elderly heart failure patients undergoing urgent hip fracture repair. Eur. J. Anaesthesiol. 2008; 25 (8): 627—633.
65. McFalls E. O., Ward H. B., Moritz T. E. et al.Coronary-artery revascular-ization before elective major vascular surgery. N. Engl. J. Med. 2004; 351 (27): 2795—2804.
66. Nisanevich V., Felsenstein I., Almogy G. et al.Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103 (1): 25—32.
67. Brandstrup B., T0nnesen H., Beier-Holgersen R. et al.Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multi-center trial. Ann. Surg. 2003; 238 (5): 641—648.
68. Rao T. L., Jacobs K. H., El-Etr A. A.Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983; 59 (6): 499—505.
69. BerlaukJ. F., AbramsJ. H., Gilmour I.J. et al.Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial. Ann. Surg. 1991; 214 (3): 289—297.
70. Bender J. S., Smith-Meek M. A., Jones C. E.Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial. Ann. Surg. 1997; 226 (3): 229—236.
71. American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiogra-phy. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 2010; 112 (5): 1084—1096.
72. Leung J. M., Voskanian A., Bellows W. H., Pastor D.Automated electrocardiograph ST segment trending monitors: accuracy in detecting myocardial ischemia. Anesth. Analg. 1998; 87 (1): 4—10.
73. Fleisher L. A.Real-time intraoperative monitoring of myocardial ischemia innoncardiac surgery. Anesthesiology 2000; 92 (4): 1183—1188.
74. Ellis J. E., Shah M. N., Briller J. E. et al.A comparison of methods for the detection of myocardial ischemia during noncardiac surgery: automated ST-segment analysis systems, electrocardiography, and trans-esophageal echocardiography. Anesth. Analg. 1992; 75 (5): 764—772.
75. London M. J., Hollenberg M., Wong M. G. et al.Intraoperative myocar-dial ischemia: localization by continuous 12-lead electrocardiography. Anesthesiology 1988; 69 (2): 232—241.
76. Fleisher L. A., Zielski M. M., Schulman S. P.Perioperative ST-segment depression is rare and may not indicate myocardial ischemia in moderate-risk patients undergoing noncardiac surgery. J. Cardiothorac. Vasc. Anesth. 1997; 11 (2): 155—159.
77. Priebe H. J.[Perioperative cardiac care for non-cardiac surgery: 2009 Guidelines of the European Society of Cardiology]. Anaesthesist 2010; 59 (5): 443—452.
78. De Hert S. G., Turani F., Mathur S., Stowe D. F.Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth. Analg. 2005; 100 (6): 1584—1593.
79. Bode R. H. Jr., Lewis K. P., Zarich S. W. et al.Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology 1996; 84 (1): 3—13.
80. Rigg J. R, Jamrozik K., Myles P. S. et al.Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359 (9314): 1276—1282.
81. Rodgers A., Walker N., Schug S. et al.Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321 (7275): 1493.
82. Noordzij P. G., Boersma E., Schreiner F. et al.Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur. J. Endocrinol. 2007; 156 (1): 137—142.
83. Feringa H. H., Vidakovic R., Karagiannis S. E. et al.Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients. Diabet Med. 2008; 25 (3): 314—319.
84. van den Berghe G., Wouters P., Weekers F. et al.Intensive insulin therapy in the critically ill patients. N. Engl. J. Med. 2001; 345 (19): 1359—1367.
85. Finfer S., Chittock D. R., Su S. Y. et al.Intensive versus conventional glucose control in critically ill patients. N. Engl. J. Med. 2009; 360 (13): 1283—1297.
86. Moghissi E. S., Korytkowski M. T., DiNardo M. et al.American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr. Pract. 2009; 15 (4): 353—369.
87. Insler S. R., Sessler D. I.Perioperative thermoregulation and temperature monitoring. Anesthesiol. Clin. 2006; 24 (4): 823—837.
88. Frank S. M., Higgins M. S., Breslow M. J. et al.The catecholamine, corti-sol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 1995; 82 (1): 83—93.
89. Polderman K. H., Girbes A. R.Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Crit. Care 2004; 8 (6): R459—R466.
Рецензия
Для цитирования:
Корниенко А.Н., Добрушина О.Р., Зинина Е.П. Профилактика кардиальных осложнений внесердечных операций . Общая реаниматология. 2011;7(5):57. https://doi.org/10.15360/1813-9779-2011-5-57
For citation:
Korniyenko A.N., Dobrushina O.R., Zinina E.P. Differentiated Prevention of Cardiac Complications of Extracardiac Surgery . General Reanimatology. 2011;7(5):57. (In Russ.) https://doi.org/10.15360/1813-9779-2011-5-57
Просмотров:
1160
Послать статью по эл. почте 