Статья
Оценка и коррекция риска кардиальных осложнений при некардиальных операциях – что нового?
Сердечно-сосудистые осложнения после некардиальных операций являются ведущей причиной 30-дневной смертности. Потребность в хирургических вмешательствах составляет примерно 5 тыс процедур на 100 тыс населения по расчетам экспертов, риски внесердечных хирургических вмешательств заметно выше у пожилых людей. Следует учитывать, что постарение населения и возросшие возможности медицины неизбежно ведут к увеличению хирургических вмешательств у лиц старшего возраста. Последние годы характеризуются появлением различных национальных и международных рекомендаций с различными алгоритмами оценки и коррекции кардиального риска, а также публикаций по валидизации этих алгоритмов. Целью настоящего обзора было представить новые сведения об оценке и коррекции риска кардиальных осложнений при некардиальных операциях. Несмотря на предложенные новые шкалы оценки риска, наиболее употребительной остается шкала RCRI, хотя для отдельных категорий больных (при онкопатологии, у лиц старших возрастных групп) показана возможность применения специфических опросников. В оценке функционального состояния предлагается использовать не только субъективную оценку, но и опросник DASI, тест шестиминутной ходьбы и кардиопульмональный нагрузочный тест). На следующем этапе предлагается оценивать биомаркеры, прежде всего, натрийуретические пептиды (BNP или NT-proBNP), при нормальном их уровне – проведение операции, при повышенном – либо дообследование у кардиолога, либо периоперационный скрининг тропонина. В настоящее время преобладает мнение, что нет необходимости обследовать пациентов для выявления скрытых поражений коронарных артерий (неинвазивные тесты, коронароангиография), поскольку это приводит к избыточному обследованию пациентов, задерживает выполнение некардиальной операции. Насколько данный подход имеет преимущество перед использовавшимся ранее, еще предстоит изучить.
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