Статья
Актуальные вопросы оценки и коррекции риска кардиальных осложнений при некардиальных операциях
Во всем мире ежегодно проводится более 200 миллионов некардиальных операций, это число постоянно возрастает, а ведущей причиной смертности при таких операциях являются кардиальные осложнения. Так, в многоцентровом исследовании, проведенном в 27 странах, кардиоваскулярные осложнения присутствовали в 68% случаев развития летального исхода в послеоперационном периоде. Регистры последних лет показали, что число таких осложнений сохраняется высоким, например, при динамической оценке тропонинов периоперационное повреждение миокарда выявлялось в 13-18% случаев. В настоящем обзоре проведен критический анализ пошагового алгоритма оценки кардиального риска некардиальных операций в свете появления новых публикаций по данной тематике. В обзоре рассмотрены новые данные по шкалам оценки риска, оценки функционального состояния, использования в предоперационном периоде неинвазивных тестов, биомаркеров, роли превентивной реваскуляризации миокарда, медикаментозной терапии. Отдельно рассмотрены вопросы некардиальных операций после чрескожного коронарного вмешательства, периоперационного повреждения миокарда. В обзоре подчеркиваются трудности в получении доказательной базы, проведении рандомизированных клинических исследований в этом разделе медицины, которые в большинстве случаев не позволяют получить однозначных выводов, и приводят к разночтениям и неясностям в рекомендациях различных групп экспертов. Настоящий обзор поможет практическим врачам ориентироваться в данном вопросе, а также формировать оптимальную диагностическую и лечебную стратегию перед выполнением некардиальных операций.
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