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Факторы риска тромботических осложнений и антитромботическая терапия кардиохирургических пациентов детского возраста

https://doi.org/10.29413/ABS.2021-6.2.9

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Аннотация

Современное развитие кардиохирургической помощи пациентам детского и неонатального возраста претерпевает стремительный рост. Выполняемые сложные этапные реконструктивные вмешательства, частое использование инвазивного мониторинга сопряжены с высоким риском развития венозных и артериальных тромбозов.

Кардиохирургический пациент является по-своему уникальным, поскольку требует контролируемой антикоагуляции во время искусственного кровообращения. И конечно же большинство кардиохирургических пациентов предполагает антитромботическое сопровождение на протяжении всего периоперационного периода. Помимо медикаментозной поддержки оправданным считается реализация мер по управлению сосудистым доступом с целью минимизации рисков тромбоэмболических осложнений, которые могут оказывать влияние как на функциональный статус пациентов, так и на общую и межстадийную летальность.

Целью настоящего обзора явилась систематизация имеющихся данных о факторах риска, способствующих развитию тромботических осложнений у пациентов с врождёнными пороками сердца.

Информационный поиск проводился с использованием Интернет-ресурсов (PubMed, Web of Science, eLibrary. ru); в анализ были включены литературные источники за период 2015–2020 гг. По результатам проведённого анализа литературных данных были описаны возраст-ассоциированные особенности системы гемостаза у пациентов с врождёнными пороками сердца, и связанные с патофизиологией дефектов и выполняемых реконструктивных вмешательств. Освещены вопросы патофизиологии унивентрикулярных врождённых пороков сердца и сопряжённые с ними факторы риска развития тромбоза. Кроме того, обсуждаются аспекты интраоперационного антитромботического сопровождения, а также меры по профилактике тромбоэмболических осложнений в данной популяции пациентов.

Координированные действия гематологов, кардиологов, анестезиологов и кардиохирургов позволят достичь тонкого баланса между рисками кровотечения и тромбоза в популяции пациентов детского возраста, подвергаемых сердечно-сосудистым вмешательствам. 

Об авторах

Н. Б. Карахалис
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России; ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского»
Россия

кандидат медицинских наук, доцент кафедры анестезиологии, реаниматологии и трансфузиологии ФПК и ППС, 350063, г. Краснодар, ул. Митрофана Седина, 4;

заведующий отделением реанимации и анестезиологии № 9, 350086, г. Иркутск, ул. 1 Мая, 167



М. Н. Карахалис
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России
Россия

клинический ординатор, кафедра лучевой диагностики, 

350063, г. Краснодар, ул. Митрофана Седина, 4



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Для цитирования:


Карахалис Н.Б., Карахалис М.Н. Факторы риска тромботических осложнений и антитромботическая терапия кардиохирургических пациентов детского возраста. Acta Biomedica Scientifica. 2021;6(2):81-91. https://doi.org/10.29413/ABS.2021-6.2.9

For citation:


Karakhalis N.B., Karakhalis M.N. Risk Factors of Thrombotic Complications and Antithrombotic Therapy in Paediatric Cardiosurgical Patients. Acta Biomedica Scientifica. 2021;6(2):81-91. (In Russ.) https://doi.org/10.29413/ABS.2021-6.2.9

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