nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2018-3-281-289nid-342Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОсобенности периоперационного ведения пациентов с терминальной стадией хронической болезни почек, нуждающихся в хирургической коррекции кардиоваскулярной патологииFeatures of perioperative management in patients with end-stage renal disease (ESRD) requiring surgical correction of cardiovascular pathologyЯрустовскийМ. Б.YaroustovskyM. B.mbyar@yandex.ruАбрамянМ. В.AbramyanM. V.noemail@neicon.ruСолдаткинаА. О.SoldatkinaA. O.noemail@neicon.ruМуратовР. М.MuratovR. M.noemail@neicon.ruБокерияО. Л.BockeriaO. L.noemail@neicon.ruКудзоеваЗ. Ф.KudzoevaZ. F.noemail@neicon.ruКомардинаЕ. В.KomardinaE. V.noemail@neicon.ruНазароваЕ. И.NazarovaE. I.noemail@neicon.ruФГБУ "НМИЦ ССХ им. А.Н. Бакулева" Министерства здравоохранения Российской ФедерацииРоссияA.N. Bakulev NMRCCS of the Ministry of Health of the Russian FederationRussian Federation201812082024203281289Copyright © Ярустовский М.Б., Абрамян М.В., Солдаткина А.О., Муратов Р.М., Бокерия О.Л., Кудзоева З.Ф., Комардина Е.В., Назарова Е.И., 20242024Ярустовский М.Б., Абрамян М.В., Солдаткина А.О., Муратов Р.М., Бокерия О.Л., Кудзоева З.Ф., Комардина Е.В., Назарова Е.И.Yaroustovsky M.B., Abramyan M.V., Soldatkina A.O., Muratov R.M., Bockeria O.L., Kudzoeva Z.F., Komardina E.V., Nazarova E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/342

Цель работы: описание особенностей периоперационного ведения больных с терминальной стадией хронической болезни почек (ХБП), нуждающихся в кардиохирургических вмешательствах. Материалы и методы: за период с 2014 по 2017 год в НМИЦ ССХ им. А.Н. Бакулева оказана кардиохирургическая помощь 20 пациентам с терминальной стадией ХБП в возрасте от 23 до 69 лет. Длительность пребывания на программном гемодиализе (ПГД) составила от 2 месяцев до 12 лет. У 75% пациентов наблюдалась ишемическая болезнь сердца (ИБС), у остальных - клапанная патология, обусловленная развитием инфекционного эндокардита (ИЭ). Результаты: у больных ИБС стентирование коронарных артерий (КА) было выполнено в 14 случаях, шунтирование КА - в 4 случаях, транслюминальная балонная ангиопластика (ТЛБАП) - в одном случае. Пяти больным были выполнены кардиохирургические вмешательства в условиях искусственного кровообращения (ИК) по поводу изолированной клапанной патологии. Предоперационная подготовка включала в себя коррекцию анемии, гипоальбуминемии, гидробаланса, нарушений водно-электролитного баланса, нормализацию артериального давления и проведение процедур заместительной почечной терапии (ЗПТ). Больным, подвергающимся "открытым" кардиохирургическим вмешательствам, выполнялась комбинированная анестезия. Анестезиологическая тактика была направлена на поддержание сердечного выброса, параметров центральной гемодинамики, волемического статуса, пациентам с анурией интраоперационно выполнялась ультрафильтрация. В послеоперационном периоде ЗПТ больным после "открытых" кардиохирургических вмешательств выполнялась со вторых послеоперационных суток, тогда как пациентам после эндоваскулярных вмешательств - в первые часы после операции. За время наблюдения летальных исходов не было. Заключение: ведение больных, нуждающихся в ЗПТ и кардиохирургических вмешательствах, представляет собой сложную и неоднозначную задачу, но не должно рассматриваться как противопоказание к проведению оперативного вмешательства.

Aim of the study: to describe the features of perioperative management in patients with the end-stage renal disease who require surgical correction of cardiovascular pathology. Materials and methods: 20 patients with the ESRD at the age of 23 to 69 who received heart surgery assistance in the A.N. Bakulev Cardio-surgery center (NMRCCS) in years 2014 to 2017. The duration of program hemodialysis was from 2 months to 12 years. Three thirds 75 % of the patients had ischemic heart disease (IHD); other had heart valve pathology due to the progression of infective endocarditis (IE). Results: stenting of coronary arteries (CA) was performed in 14 of ischemic hard disease (IHD) patients; bypass grafting of CA was performed in 4 cases, transluminal balloon angioplasty (TBA) was performed in one case. Five patients underwent heart surgery interventions involving cardiopulmonary bypass (CB) in regard to the isolated valve pathology. Preoperative preparation procedures included correction of anemia, hypoalbuminemia, water balance, fluid and electrolyte balance disorders, normalization of arterial pressure and procedures of renal replacement therapy (RRT). "Open" heart surgery interventions were performed with combined anesthesia. Anesthesia tactics was aimed to maintaining of heart ejection, central hemodynamic parameters and volume status; ultrafiltration was applied to the patients with anuria. In the post-operative period patients underwent RRT after "open" heart surgery interventions, beginning from the second post-operative day, while patients after endovascular interventions - within the first hours after the operation. Nobody died during the observation. Conclusion: treatment of patients with the ESRD on program hemodialysis who need cardiac surgical interventions is a complex and difficult problem. However, the ESRD should not be considered as a contraindication for surgical intervention.

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The authors declare that there are no conflicts of interest present.