20 research outputs found
ΠΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΡ ΠΈ ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π΅ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ
Aim. To compare the possibilities of venoarterial extracorporeal membrane oxygenation (VA ECMO) and intra-aortic balloon pump (IABP) to prevent organ damage and the development of multiple organ failure.Methods. According to the inclusion and exclusion criteria, 51 patients underwent the study. The patients were divided into 2 groups depending on the method of mechanical circulatory support used: VA ECMO (n = 29) and IABP (n = 22). To assess organ functions in the intra- and postoperative period, the results of instrumental and laboratory research methods, as well as data from complex scales of organ dysfunction, were analased.Results. Myocardial depression was observed in the IABP group in the intraoperative period of high-risk percutaneous coronary intervention and worse hemodynamic stability compared to the VA ECMO group was traced. Organ dysfunction and multiorgan failure developed more often in the IABP group, which was confirmed by laboratory specific markers.Conclusion. High-risk percutaneous coronary intervention with VA ECMO is accompanied by a lower incidence and severity of organ damage and multiple organ failure. Thus, the VA ECMO has better organ protective effects.Β Π¦Π΅Π»Ρ. Π‘ΡΠ°Π²Π½ΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π²Π΅Π½ΠΎΠ°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ (ΠΠ ΠΠΠΠ) ΠΈ Π²Π½ΡΡΡΠΈΠ°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠΏΡΠ»ΡΡΠ°ΡΠΈΠΈ (ΠΠΠΠ) ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π°ΡΡ ΠΎΡΠ³Π°Π½Π½ΠΎΠ΅ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ ΠΈ ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΡ, Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΎΡΠ΅Π» 51 ΠΏΠ°ΡΠΈΠ΅Π½Ρ. Π Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΠΌΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΠ΅ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ: ΠΠ ΠΠΠΠ (n = 29) ΠΈ ΠΠΠΠ (n = 22). Π‘ ΡΠ΅Π»ΡΡ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΎΡΠ³Π°Π½Π½ΡΡ
ΡΡΠ½ΠΊΡΠΈΠΉ Π² ΠΈΠ½ΡΡΠ°- ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡΡ
ΡΠΊΠ°Π» ΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠΠΠ ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ Π΄Π΅ΠΏΡΠ΅ΡΡΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΠΈ Ρ
ΡΠ΄ΡΠ°Ρ, Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ ΠΠ ΠΠΠΠ, Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡ. ΠΡΠ³Π°Π½Π½Π°Ρ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ ΠΈ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½Π°Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡ ΡΠ°ΡΠ΅ ΡΠ°Π·Π²ΠΈΠ²Π°Π»ΠΈΡΡ Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠΠΠ, ΡΡΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½ΠΎ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠΌΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠ°ΠΌΠΈ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π§ΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ΅ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΠ ΠΠΠΠ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°Π΅ΡΡΡ ΠΌΠ΅Π½ΡΡΠΈΠΌΠΈ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡΡ ΠΎΡΠ³Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΈ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΠΠ ΠΠΠΠ ΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π»ΡΡΡΠ΅Π΅ ΠΎΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅.
IMMUNOSUPPRESSION AS A COMPONENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME FOLLOWING CARDIAC SURGERY
Aim. To defne the role of myeloid-derived suppressor cells in the development of persistent multiple organ dysfunction followed cardiac surgeries with cardiopulmonary bypass.Methods. 40 patients who have undergone cardiac surgery were included in the study. Granulocyte myeloid-derived suppressor cells (G-MDSC) were defned as cells with the HLA-DRβ / CD11Ξ²+ / CD15+ / CD33+ phenotype, and monocytic MDSC (M-MDSC) as cells with the HLA-DRβ / CD11Ξ²+ / CD14+ / CD33+ phenotype using ο¬ow cytometry. Levels of cytokines, IL-1Ξ², IL-6, TNF-Ξ±, and IL-10 were measured with an enzyme immunoassay. All patients were assigned to three groups: Group 1 β patients with the uncomplicated postoperative period (n = 14), Group 2 β patients with non-persistent MODS and its early resolution (n = 16), and Group 3 β patients with persistent MODS at day 7.Results. We observed an increase in M-MDSCs and G-MDSC at day 1 following cardiac surgery. The most pronounced increase was found in monocytic-myeloid derived suppressor cells, i.e. an 8-fold increase in M-MDSCs in all study groups at day 1 after surgery. The number of M-MDSCs remained high in patients with persistent MODS at day 7 after cardiac surgery. Levels of IL-6 and IL-10 increased at day 1 after surgery. IL-6 reached its peak level, signifcantly exceeding baseline levels. By day 7, blood levels of all cytokines have decreased, except IL-10 levels, which remained above the baseline in patients with persistent MODS.Conclusion. An increase in M-MDSCs and elevated serum levels of the anti-inο¬ammatory cytokine IL-10 have been found in patients regardless of the presence or absence of the complications in the early postoperative period after cardiac surgery with cardiopulmonary bypass. Persistent MODS with the SOFA scoring > 5 scores at day 7 after cardiac surgery, is associated with an increase in M-MDSCs and elevated levels of the anti-inο¬ammatory cytokine IL-10, related to higher rate of hospital infections, prolonged intensive care unit stay and higher mortality.Aim. To defne the role of myeloid-derived suppressor cells in the development of persistent multiple organ dysfunction followed cardiac surgeries with cardiopulmonary bypass.Methods. 40 patients who have undergone cardiac surgery were included in the study. Granulocyte myeloid-derived suppressor cells (G-MDSC) were defned as cells with the HLA-DRβ / CD11Ξ²+ / CD15+ / CD33+ phenotype, and monocytic MDSC (M-MDSC) as cells with the HLA-DRβ / CD11Ξ²+ / CD14+ / CD33+ phenotype using ο¬ow cytometry. Levels of cytokines, IL-1Ξ², IL-6, TNF-Ξ±, and IL-10 were measured with an enzyme immunoassay. All patients were assigned to three groups: Group 1 β patients with the uncomplicated postoperative period (n = 14), Group 2 β patients with non-persistent MODS and its early resolution (n = 16), and Group 3 β patients with persistent MODS at day 7.Results. We observed an increase in M-MDSCs and G-MDSC at day 1 following cardiac surgery. The most pronounced increase was found in monocytic-myeloid derived suppressor cells, i.e. an 8-fold increase in M-MDSCs in all study groups at day 1 after surgery. The number of M-MDSCs remained high in patients with persistent MODS at day 7 after cardiac surgery. Levels of IL-6 and IL-10 increased at day 1 after surgery. IL-6 reached its peak level, signifcantly exceeding baseline levels. By day 7, blood levels of all cytokines have decreased, except IL-10 levels, which remained above the baseline in patients with persistent MODS.Conclusion. An increase in M-MDSCs and elevated serum levels of the anti-inο¬ammatory cytokine IL-10 have been found in patients regardless of the presence or absence of the complications in the early postoperative period after cardiac surgery with cardiopulmonary bypass. Persistent MODS with the SOFA scoring > 5 scores at day 7 after cardiac surgery, is associated with an increase in M-MDSCs and elevated levels of the anti-inο¬ammatory cytokine IL-10, related to higher rate of hospital infections, prolonged intensive care unit stay and higher mortality
ΠΠ½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΡΠΈΡΡΠΎΡΠΈΡΡΠΎΠ΄Π΅ΡΠΆΠ°ΡΠΈΡ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π°ΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΊΠΎΠ½ΡΡΡΠ° ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π² ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ Π²ΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ ΠΏΠΎΡΠΎΠΊΠΎΠ² ΡΠ΅ΡΠ΄ΡΠ° Ρ Π΄Π΅ΡΠ΅ΠΉ
Various pathological factors accompanying any cardiac surgery can cause intraoperative systemic inο¬ammatory responses (SIR). As the number of cardiac surgical interventions grows worldwide, the issue of SIR prevention appears highly relevant.Aim of the study. To determine the eο¬ect of not using donor blood components in the priming of the cardiopulmonary bypass circuit in children with septal congenital heart defects, operated under cardiopulmonary bypass, on the severity of SIR.Material and methods. A prospective, randomized study included 40 children with a median age of 14 [12β22.5] months and weight of 8.8 [7.25β11] kg. All patients underwent radical correction of septal defect under cardiopulmonary bypass. The patients were divided into two groups depending on the use of donor blood components for priming the CPB. The severity of SIR was assessed using four speciο¬c serum biomarkers such as interleukin 1b (IL-1b), interleukin 6 (IL-6), interleukin 10 (IL-10), and tumor necrosis factor alpha (TNF-Ξ±), measured before the operation, after the CPB and 16 hours after the surgery. In addition, the intra- and postoperative periods were evaluated.Results. The safety of the proposed strategy of skipping the donor blood was confirmed by lack of any organ dysfunction in all patients, as well as a significant difference in the balance of oxygen delivery and consumption. In addition, the levels of systemic inflammation markers after CPB were significantly higher in patients who had transfusion: IL-1b was 3.3 [3.2β3.48] pg/mL vs 2.86 [2.7β3.11] pg/mL (P=0.003) and TNF-Ξ± reached 1.81 [1.37β3.3] pg/mL vs 1.33 [1.26β1.76] pg/mL (P=0.034). Meanwhile, 16 hours post surgery, IL-6 and IL-10 levels were significantly higher in the group using donor blood components with IL-6 being 48.91 [33.89β57.6] pg/mL vs 31.56 [26.83β48.89] pg/mL (P=0.087) and IL-10 reaching 0.8 [0.76β1.43] pg/mL vs 0.69 [0.6β0.83] pg/mL (P=0.005).Conclusion. The study demonstrates and conο¬rms the safety and eο¬cacy of cardiopulmonary bypass without using donor blood components to reduce the severity of the systemic inο¬ammatory response in children undergoing correction of septal congenital heart defects.ΠΠΎΠ»ΡΡΠΎΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π½ΡΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ², ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°ΡΡΠΈΡ
Π»ΡΠ±ΡΡ ΠΊΠ°ΡΠ΄ΠΈΠΎΡ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ, ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ° (Π‘ΠΠ) Π² ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅. Π£ΡΠΈΡΡΠ²Π°Ρ Π΅ΠΆΠ΅Π³ΠΎΠ΄Π½ΡΠΉ ΡΠΎΡΡ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΊΠ°ΡΠ΄ΠΈΠΎΡ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ² Π² ΠΌΠΈΡΠ΅, Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ²Π»ΡΠ΅ΡΡΡ Π·Π°Π΄Π°ΡΠ° ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Π‘ΠΠ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΠΎΡΠΊΠ°Π·Π° ΠΎΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π°ΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ° ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΡΠΌΠΈ Π²ΡΠΎΠΆΠ΄Π΅Π½Π½ΡΠΌΠΈ ΠΏΠΎΡΠΎΠΊΠ°ΠΌΠΈ ΡΠ΅ΡΠ΄ΡΠ° (ΠΠΠ‘), ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ (ΠΠ), Π½Π° Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΡ Π‘ΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅, ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 40 Π΄Π΅ΡΠ΅ΠΉ, ΠΌΠ΅Π΄ΠΈΠ°Π½Π½ΡΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΊΠΎΡΠΎΡΡΡ
ΡΠΎΡΡΠ°Π²ΠΈΠ» 14 [12β22,5] ΠΌΠ΅ΡΡΡΠ΅Π², Π²Π΅Ρ β 8,8 [7,25β11] ΠΊΠ³. ΠΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΡΡ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΡΡ
ΠΠΠ‘ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΠ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ°Π·Π΄Π΅Π»ΠΈΠ»ΠΈ Π½Π° 2 Π³ΡΡΠΏΠΏΡ, Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π°ΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ° ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ. Π‘ΡΠ΅ΠΏΠ΅Π½Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π‘ΠΠ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠ΅ΡΡΡΠ΅Ρ
ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π² ΡΡΠ²ΠΎΡΠΎΡΠΊΠ΅ ΠΊΡΠΎΠ²ΠΈ: ΠΈΠ½ΡΠ΅ΡΠ΅Π»Π΅ΠΉΠΊΠΈΠ½ 1b (IL-1b), ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½ 6 (IL-6), ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½ 10 (IL-10) ΠΈ ΡΠ°ΠΊΡΠΎΡ Π½Π΅ΠΊΡΠΎΠ·Π° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π°Π»ΡΡΠ° (TNF-Ξ±), ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½Π½ΡΡ
Π΄ΠΎ Π½Π°ΡΠ°Π»Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΠΏΠΎΡΠ»Π΅ Π·Π°Π²Π΅ΡΡΠ΅Π½ΠΈΡ ΠΠ ΠΈ ΡΠ΅ΡΠ΅Π· 16 ΡΠ°ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, ΠΏΡΠΎΠ²Π΅Π»ΠΈ Π°Π½Π°Π»ΠΈΠ· ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΈΠ½ΡΡΠ°- ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΡ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΠΎΠΉ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ ΠΎΡΠΊΠ°Π·Π° ΠΎΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠ΄ΠΈΠ»ΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ΠΌ ΠΊΠ°ΠΊΠΈΡ
-Π»ΠΈΠ±ΠΎ ΠΎΡΠ³Π°Π½Π½ΡΡ
Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΉ Ρ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ Π·Π½Π°ΡΠΈΠΌΠΎΠΉ ΡΠ°Π·Π½ΠΈΡΡ ΠΏΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌ Π±Π°Π»Π°Π½ΡΠ° Π΄ΠΎΡΡΠ°Π²ΠΊΠΈ ΠΈ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π°. ΠΠΎΠΌΠΈΠΌΠΎ ΡΡΠΎΠ³ΠΎ, Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π‘ΠΠ IL-1b (pg/ml) β 2,86 [2,7β3,11] vs 3,3 [3,2β3,48] (p=0,003) ΠΈ TNF-Ξ± (pg/ml) β 1,33 [1,26β1,76] vs 1,81 [1,37β3,3] (p=0,034) ΠΈΠΌΠ΅Π»ΠΈ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΡΡΠ΅Π΄ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠ°Π½ΡΡΡΠ·ΠΈΠ΅ΠΉ Π² ΡΠΎΡΠΊΠ΅ ΠΏΠΎΡΠ»Π΅ Π·Π°Π²Π΅ΡΡΠ΅Π½ΠΈΡ ΠΠ. ΠΡΠΈ ΡΡΠΎΠΌ IL-6 (pg/ml) β 31,56 [26,83β48,89] vs 48,91 [33,89β57,6] (p=0,087) ΠΈ IL-10 (pg/ml) β 0,69 [0,6β0,83] vs 0,8 [0,76β1,43] (p=0,005) Π±ΡΠ»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π²ΡΡΠ΅ Π² Π³ΡΡΠΏΠΏΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ ΡΠ΅ΡΠ΅Π· 16 ΡΠ°ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Π° ΠΈ Π΄ΠΎΠΊΠ°Π·Π°Π½Π° Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΡ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π±Π΅Π· ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Π΄ΠΎΠ½ΠΎΡΡΠΊΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ Π΄Π»Ρ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ° Ρ Π΄Π΅ΡΠ΅ΠΉ ΠΏΡΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΡΡ
Π²ΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
ΠΏΠΎΡΠΎΠΊΠΎΠ² ΡΠ΅ΡΠ΄ΡΠ°
ΠΠ½Π°Π»ΠΈΠ· Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΡΡ ΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ°
Aim. To analyze in-hospital and long-term (12 months) results of percutaneous coronary intervention (PCI) supported by extracorporeal membrane oxygenation (ECMO) in patients with stable coronary heart disease and multivessel coronary artery disease, and to justify the use of such approach in the treatment of this group of patients.Methods. The retrospective analysis included 13 patients with stable coronary artery and multivessel coronary disease. The mean SYNTAX score before the intervention was 31.4Β±10.8. Between 30 days and 12 months in the postoperative period, the frequency and type of the following major adverse cardiovascular events (MACE) was assessed: all-cause death, myocardial infarction, stroke, repeat revascularization. Twelve months after the event, the data on the frequency and type of adverse cardiovascular events were collected by means of telephone follow-up.Results. Coronary intervention supported by ECMO was performed in all patients. 8 (61.6%) patients required an open surgical approach for ECMO cannula insertion. Door to balloon time was 109.6Β±79.2 minutes. The mean duration of ECMO support was 101.7Β±45.4 minutes. Haemodynamic instability, abnormalities in pulmonary gas exchange and rhythm disturbances were not revealed during primary PCI, making it possible to wean off the ECMO post-PCI. The mean residual SYNTAX score was 9.3Β±11.8. BARC class β₯3 bleeding complications were observed in 6 of 13 patients. Long-term major adverse cardiovascular events with fatal outcomes occurred in 3 (23.1%) patients.Conclusion. Supporting high-risk PCI with ECMO in patients with stable coronary artery disease, multivessel coronary artery disease and low left ventricular ejection fraction made it possible to successfully perform the intervention in all patients. Nevertheless, the long-term (12 months) results show a high percentage of recurrent myocardial infarction, which can be associated with high residual SYNTAX score.Π¦Π΅Π»Ρ. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΡΠ΅ ΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ (12 ΠΌΠ΅Ρ.) ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° (Π§ΠΠ) Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ (ΠΠΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ° (ΠΠΠ‘) ΠΈ ΠΌΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ (ΠΠ) Ρ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° ΠΏΡΠΈ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 13 Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΠΠΠ‘ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΌΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΠ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π±Π°Π»Π» ΠΏΠΎ ΡΠΊΠ°Π»Π΅ SYNTAX ΠΏΠ΅ΡΠ΅Π΄ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎΠΌ ΡΠΎΡΡΠ°Π²ΠΈΠ» 31,4Β±10,8. Π ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΎΡΠ΅Π½Π΅Π½Π° ΡΠ°ΡΡΠΎΡΠ° ΠΈ ΡΡΡΡΠΊΡΡΡΠ° ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΉ ΡΠΎΡΠΊΠΈ, Π²ΠΊΠ»ΡΡΠ°ΡΡΠ΅ΠΉ ΡΠ΅ΡΡΠ΅Π·Π½ΡΠ΅ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠ΅ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠ΅ ΡΠΎΠ±ΡΡΠΈΡ (MACCE): ΡΠΌΠ΅ΡΡΡ ΠΎΡ Π²ΡΠ΅Ρ
ΠΏΡΠΈΡΠΈΠ½, ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, ΠΈΠ½ΡΡΠ»ΡΡ, ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π½Π° ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ 30 Π΄Π½Π΅ΠΉ ΠΈ 12 ΠΌΠ΅Ρ. Π§Π΅ΡΠ΅Π· 12 ΠΌΠ΅Ρ. ΠΏΠΎΡΠ»Π΅ ΠΈΠ½Π΄Π΅ΠΊΡΠ½ΠΎΠ³ΠΎ ΡΠΎΠ±ΡΡΠΈΡ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΠ΅Π»Π΅ΡΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΠΎΡΠ° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ ΡΡΠ΅Ρ ΡΠ°ΡΡΠΎΡΡ ΠΈ ΡΡΡΡΠΊΡΡΡΡ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΡ
ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΡ
ΡΠΎΠ±ΡΡΠΈΠΉ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ ΠΠΠΠ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Π²ΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ. ΠΠΎΡΡΠΌΠΈ (61,6%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΡΡΡΠ°Π½ΠΎΠ²ΠΊΠ° ΠΊΠ°Π½ΡΠ»Ρ ΠΠΠΠ ΠΏΡΠΎΠΈΠ·Π²Π΅Π΄Π΅Π½Π° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠΏΠΎΡΠΎΠ±ΠΎΠΌ. Π ΠΎΡΡΠ°Π»ΡΠ½ΡΡ
ΡΠ»ΡΡΠ°ΡΡ
ΠΊΠ°Π½ΡΠ»ΠΈ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°Π»ΠΈ ΠΏΡΠ½ΠΊΡΠΈΠΎΠ½Π½ΠΎ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΡΡΠΈΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΡΠ΅Π½ΠΊΠΈ ΡΡΡΡΠΎΠΉΡΡΠ²ΠΎΠΌ ProStar XL. ΠΠ»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠΎΡΠ΅Π΄ΡΡΡ Π§ΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 109,6Β±79,2 ΠΌΠΈΠ½. Π‘ΡΠ΅Π΄Π½Π΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΏΠΎΠ΄ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ° ΠΠΠΠ β 101,7Β±45,4 ΠΌΠΈΠ½. ΠΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ ΡΡΠ°ΠΏΠ° Π§ΠΠ ΡΠ΅ΡΡΠ΅Π·Π½ΡΡ
ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ, Π³Π°Π·ΠΎΠΎΠ±ΠΌΠ΅Π½Π° ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΡΠΈΡΠΌΠ° Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΠΎΡΠΊΠ»ΡΡΠΈΡΡΡΡ ΠΎΡ ΡΠΈΡΠΊΡΠ»ΡΡΠΎΡΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ Π² ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΠΎΡΠ»Π΅ Π§ΠΠ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΉ Π±Π°Π»Π» ΠΏΠΎ ΡΠΊΠ°Π»Π΅ SYNTAX ΡΠΎΡΡΠ°Π²ΠΈΠ» 9,3Β±11,8. ΠΠ΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ BARC β₯3 ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ Ρ 6 ΠΈΠ· 13 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠ΅ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΡΠ΅ ΡΠΎΠ±ΡΡΠΈΡ Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΡΠΌ ΠΈΡΡ
ΠΎΠ΄ΠΎΠΌ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½Ρ Π² 3 (23,1%) ΡΠ»ΡΡΠ°ΡΡ
.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠΠΠ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ ΠΏΡΠΈ Π§ΠΠ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΠΠΠ‘ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΌΠ½ΠΎΠ³ΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΠ ΠΈ Π½ΠΈΠ·ΠΊΠΎΠΉ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ Π²ΡΠΏΠΎΠ»Π½ΠΈΡΡ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π²ΡΠ΅ΠΌ ΡΡΠ°ΡΡΠ½ΠΈΠΊΠ°ΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. Π’Π΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ (12 ΠΌΠ΅Ρ.) ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΏΡΠΎΡΠ΅Π½Ρ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠ°ΡΠΊΡΠ° ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, ΡΡΠΎ, Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, ΡΠ²ΡΠ·Π°Π½ΠΎ Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΌ Π±Π°Π»Π»ΠΎΠΌ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Syntax
ΠΠ΅Ρ Π°Π½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠ° ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ ΠΏΡΠΈ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π΅ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°
High-risk percutaneous coronary intervention involves technical challenges in performing revascularization, hemodynamic instability and heart rate variability, and possible complications. Mechanical circulatory support devices ensure hemodynamic stability and expansion of opportunities for revascularization. Current methods include the following devices: intra-aortic balloon counterpulsation, Impella, TandemHeart, and venoarterial extracorporeal membrane oxygenation. The review accumulates current evidences on the use of these devices for mechanical circulatory support during high-risk percutaneous coronary intervention from the reports, registries, randomized and observational studies, as well as clinical trials.Π§ΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ΅ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΠΎΠ΄ΡΠ°Π·ΡΠΌΠ΅Π²Π°Π΅Ρ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ, Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΌΠ° ΠΈ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΠΈ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΡΠΏΠΎΡΠΎΠ±ΠΎΠ² ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΈ ΡΠ°ΡΡΠΈΡΠ΅Π½ΠΈΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠ΅ΠΉ Π΄Π»Ρ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΡΠ²Π»ΡΡΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΡΡΠΎΠΉΡΡΠ² ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ. ΠΠ° Π΄Π°Π½Π½ΡΠΉ ΠΌΠΎΠΌΠ΅Π½Ρ Π°ΡΡΠ΅Π½Π°Π» ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΡΠ»Π΅Π΄ΡΡΡΠΈΠΌΠΈ ΡΡΡΡΠΎΠΉΡΡΠ²Π°ΠΌΠΈ: Π²Π½ΡΡΡΠΈΠ°ΠΎΡΡΠ°Π»ΡΠ½Π°Ρ Π±Π°Π»Π»ΠΎΠ½Π½Π°Ρ ΠΊΠΎΠ½ΡΡΠΏΡΠ»ΡΡΠ°ΡΠΈΡ, Impella, TandemHeart ΠΈ Π²Π΅Π½ΠΎ-Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½Π°Ρ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΡ. Π ΠΎΠ±Π·ΠΎΡΠ΅ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ Π°ΠΊΡΡΠ°Π»ΡΠ½ΡΠ΅ ΡΠΎΠΎΠ±ΡΠ΅Π½ΠΈΡ, Π΄Π°Π½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΠΎΠ², ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΈ Π½Π°Π±Π»ΡΠ΄Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Ρ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΡΡΠΈΡ
ΡΡΡΡΠΎΠΉΡΡΠ² Π΄Π»Ρ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°
ΠΠ‘ΠΠΠΠΠΠΠ‘Π’Π ΠΠΠΠΠΠΠ‘Π’ΠΠΠ Π ΠΠΠ§ΠΠΠΠ― Π’Π―ΠΠΠΠΠ ΠΠΠ Π’ΠΠΠ¬ΠΠΠ ΠΠΠΠΠ‘Π’ΠΠ’ΠΠ§ΠΠΠ‘Π’Π Π£ ΠΠΠΠ ΠΠ‘Π’ΠΠ 14 ΠΠΠ’ ΠΠ Π€ΠΠΠ ΠΠΠ‘ΠΠΠΠΠΠ Π‘ΠΠΠΠΠΠΠ’ΠΠΠ¬ΠΠΠ Π’ΠΠΠΠ (ΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ Π‘ΠΠ£Π§ΠΠ)
Medical records of a patient presented with severe aortic and mitral regurgitation and connective tissue dysplasia were reviewed. Clinical, laboratory and instrumental findings were collected at baseline and after the surgery. Long-term outcomes, including quality of life, were estimated.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠ°ΡΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π΄Π΅ΡΡΠΊΠΎΠ³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ° Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ Π°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΌΠΈΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ»Π°ΠΏΠ°Π½ΠΎΠ² Π½Π° ΡΠΎΠ½Π΅ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° Π½Π΅Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΠΈ ΡΠΎΠ΅Π΄ΠΈΠ½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ. ΠΠ·ΡΡΠ°Π»Π°ΡΡ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
, Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ Π΄ΠΎ ΠΈ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ, Π²ΠΊΠ»ΡΡΠ°Ρ ΠΎΡΠ΅Π½ΠΊΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ
ΠΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ ΠΈ Π²Π½ΡΡΡΠΈΠ°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠΏΡΠ»ΡΡΠ°ΡΠΈΠΈ ΠΏΡΠΈ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π΅ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΡΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ
Purpose of the study: to evaluate the organoprotective eο¬ects of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump during high-risk percutaneous coronary intervention in acute coronary syndrome.Materials and methods. Patients required mechanical circulatory support (n=51) were divided into two study groups: patients who received mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation (ECMO) (Group 1, n=29) during high-risk percutaneous coronary intervention, and Group 2 patients who received mechanical circulatory support by intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention (Group 2, n=22). The dynamics of instrumental parameters and laboratory markers of organ damage were evaluated by electrocardiography, echocardiography, determining troponin I, creatine phosphokinases and creatinine levels, NGAL, venous blood saturation to compare the organoprotective properties of mechanical circulation support in the intra- and postoperative period.Results. The following values of the parameters were found the next day after the intervention: troponin I β 0.18 (0.1; 2.3) ng/ml in the ECMO group and 1.64 (0.92; 2.36) ng/ml in the IABP group (P=0.045); serum NGAL β139.4 (88.1; 166.7) ng/ml in the ECMO group and 212.3 (102; 279) in the IABP group (P=0.027); renal dysfunction (stages R, I, F according to RIFLE) β 2 (6.8%) observations in the ECMO group and 7 (31.8%) in the IABP group (P=0.021); multiple organ failure (2 or more points according to SOFA) β 3 (10.3%) cases in the ECMO group and 12 (54.5%) in the IABP group (P=0.001).Conclusion. Veno-arterial ECMO in comparison with IABP has a more pronounced organoprotective eο¬ect by achieving better hemodynamic stability, which, in turn, prevents hypoxia and the subsequent development of organ dysfunction. In addition, in conditions of veno-arterial ECMO, better completeness and quality of revascularization is ensured, and hospital mortality is also reduced.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΎΡΠ΅Π½ΠΈΡΡ ΠΎΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ Π²Π΅Π½ΠΎ-Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ (ΠΠΠΠ) ΠΈ Π²Π½ΡΡΡΠΈΠ°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠΏΡΠ»ΡΡΠ°ΡΠΈΠΈ (ΠΠΠΠ) Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° (Π§ΠΠ ΠΠ ) ΠΏΡΠΈ ΠΎΡΡΡΠΎΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 51 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈ ΡΠ°Π·Π΄Π΅Π»ΠΈΠ»ΠΈ Π½Π° Π΄Π²Π΅ ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΠ΅ Π³ΡΡΠΏΠΏΡ. ΠΡΡΠΏΠΏΠ° 1 (Π§ΠΠ+ΠΠΠΠ) n=29 β ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΎΠΊΠ°Π·ΡΠ²Π°Π»Π°ΡΡ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠ° ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π² Π²ΠΈΠ΄Π΅ Π²Π΅Π½ΠΎ-Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ. ΠΡΡΠΏΠΏΠ° 2 (Π§ΠΠ+ΠΠΠΠ) n=22 β ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΠΎ Π²ΡΠ΅ΠΌΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΎΠΊΠ°Π·ΡΠ²Π°Π»Π°ΡΡ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠ° ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π² Π²ΠΈΠ΄Π΅ Π²Π½ΡΡΡΠΈΠ°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π±Π°Π»Π»ΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠΏΡΠ»ΡΡΠ°ΡΠΈΠΈ. ΠΠ»Ρ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ ΠΎΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
ΡΠ²ΠΎΠΉΡΡΠ² ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π² ΠΈΠ½ΡΡΠ°β ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΎΡΠ³Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ: ΡΠ»Π΅ΠΊΡΡΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΠΌΠΌΡ, ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΠΌΠΌΡ, ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΡ ΡΡΠΎΠΏΠΎΠ½ΠΈΠ½Π° I, ΠΎΠ±ΡΠ΅ΠΉ ΠΈ ΠΠ ΡΡΠ°ΠΊΡΠΈΠΈ ΠΊΡΠ΅Π°ΡΠΈΠ½ΡΠΎΡΡΠΎΠΊΠΈΠ½Π°Π·Ρ, ΠΊΡΠ΅Π°ΡΠΈΠ½ΠΈΠ½Π°, NGAL, ΡΠ°ΡΡΡΠ°ΡΠΈΠΈ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ ΠΊΡΠΎΠ²ΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ° ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅ ΡΡΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΈ ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ²: ΡΡΠΎΠΏΠΎΠ½ΠΈΠ½ I β 0,18 (0,1; 2,3) Π½Π³/ΠΌΠ» Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ ΠΈ 1,64 (0,92; 2,36) Π½Π³/ΠΌΠ» Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ (p=0,045); ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΡΠΉ NGAL β 139,4 (88,1; 166,7) Π½Π³/ΠΌΠ» Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ ΠΈ 212,3 (102; 279) Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ (p=0,027); ΠΏΠΎΡΠ΅ΡΠ½Π°Ρ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ (ΡΡΠ°Π΄ΠΈΠΈ R, I, F ΠΏΠΎ RIFLE) β 2 (6,8%) Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ ΠΈ 7 (31,8%) Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ (p=0,021); ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½Π°Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡ (2 ΠΈ Π±ΠΎΠ»Π΅Π΅ Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ SOFA) β 3 (10,3%) Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ ΠΈ 12 (54,5%) Π² Π³ΡΡΠΏΠΏΠ΅ Π§ΠΠ+ΠΠΠΠ (p=0,001).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ΅Π½ΠΎ-Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ ΠΠΠΠ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΠΠΠ ΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΉ ΠΎΡΠ³Π°Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΡΡΡΠ΅ΠΊΡ ΠΏΡΡΠ΅ΠΌ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ, ΡΡΠΎ, Π² ΡΠ²ΠΎΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ, ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π°Π΅Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π³ΠΈΠΏΠΎΠΊΡΠΈΠΈ ΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Π²Π΅Π½ΠΎ-Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΠΠΠ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°Π΅ΡΡΡ Π»ΡΡΡΠ΅Π΅ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΈ ΠΏΠΎΠ»Π½ΠΎΡΠ° ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠ½ΠΈΠΆΠ°Π΅ΡΡΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½Π°Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ
ΠΠ°ΡΠ΄ΠΈΠΎΠ³Π΅Π½Π½ΡΠΉ ΡΠΎΠΊ: ΠΎΠ±Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅
Cardiogenic shock is a critical condition characterized by rapid development of multiple organ dysfunction in the absence of intensive care. The article describes AbstractΒ Β Β modern concepts about pathophysiology and approaches to treat intensive care. The concept of phased therapy as well as methods of mechanical circulatory support are discussed. The working algorithm for choosing the optimal method was proposed.ΠΠ°ΡΠ΄ΠΈΠΎΠ³Π΅Π½Π½ΡΠΉ ΡΠΎΠΊ - ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠ΅Π΅ΡΡ ΠΌΠΎΠ»Π½ΠΈΠ΅Π½ΠΎΡΠ½ΡΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΎΡΡΡΡΡΡΠ²ΠΈΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. Π ΡΡΠ°ΡΡΠ΅ ΠΎΠΏΠΈΡΠ°Π½Ρ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΎ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡΡ
ΠΏΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅ΡΡΡ ΠΊΠΎΠ½ΡΠ΅ΠΏΡΠΈΡ Β«ΡΠ°Π·Π½ΠΎΡΡΠΈΒ» ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΡΠΏΠΎΡΠΎΠ±Ρ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ ΠΈ ΠΏΡΠ΅Π΄Π»Π°Π³Π°Π΅ΡΡΡ ΡΠ°Π±ΠΎΡΠΈΠΉ Π°Π»Π³ΠΎΡΠΈΡΠΌ Π²ΡΠ±ΠΎΡΠ° ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π°
ΠΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½Π°Ρ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½Π°Ρ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΡ ΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄Π΅ΡΠΎΠΊΡΠΈΠΊΠ°ΡΠΈΠΈ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π²ΠΈΡΡΡΠ½ΠΎΠ±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π½ΠΎΠΉ Π²ΠΈΡΡΡΠΎΠΌ Π³ΡΠΈΠΏΠΏΠ° A(H1N1) Ρ ΡΠΎΠ΄ΠΈΠ»ΡΠ½ΠΈΡΡ
Outbreaks of viral infections have become a global healthcare challenge over the last decade. The 2009β2010 flu A (H1N1) outbreak resulted in global pandemia, associated with high morbidity and mortality reaching 31%. Another flu A (H1N1) outbreak occurred in 2015β2016. There is a strong probability that it may be repeated in the future. This infection is associated with its high incidence among pregnant women. There are some published reports describing the efficacy and safety of veno%venous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome that is refractory to standard therapeutic options. The article presents a clinical case of a successful use of extracorporeal membrane oxygenation and intermittent renal replacement therapy in a puerpera with acute respiratory distress syndrome caused by flu A (H1N1)-related severe viral and bacterial pneumonia. The positive effects of the combination of veno%venous extracorporeal membrane oxygenation and modern detoxification techniques have been demonstrated. Revealed organizational problemswere related to selection criteria for prescription of extracorporeal gas exchange, as well as to carrying out the procedure in an institution in the deficiency of the experienced staff and corresponding equipment.ΠΡΠΏΡΡΠΊΠΈ Π²ΠΈΡΡΡΠ½ΡΡ
ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΉ Π² ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅Π΅ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠΈΠ΅ ΡΡΠ°Π»ΠΈ ΡΠ΅ΡΡΠ΅Π·Π½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π΄Π»Ρ ΠΌΠΈΡΠΎΠ²ΠΎΠ³ΠΎ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ. ΠΠΎΠ»Π½ΠΈΠ΅Π½ΠΎΡΠ½ΠΎΠ΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ Π³ΡΠΈΠΏΠΏΠ° Π (H1N1) Π² 2009β2010 Π³Π³. , Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠ΅Π΅ΡΡ Π²ΡΡΠΎΠΊΠΎΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΡΡ ΠΈ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΡΡ, Π΄ΠΎΡΡΠΈΠ³Π°ΡΡΠ΅ΠΉ 31%, ΠΏΡΠΈΠ²Π΅Π»ΠΎ ΠΏΠΎ ΡΡΡΠΈ ΠΊ ΠΏΠ°Π½Π΄Π΅ΠΌΠΈΠΈ, Π·Π°ΡΡΠΎΠ½ΡΠ²ΡΠ΅ΠΉ Π²Π΅ΡΡ Π·Π΅ΠΌΠ½ΠΎΠΉ ΡΠ°Ρ. ΠΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΠΏΠ°Π½Π΄Π΅ΠΌΠΈΡ Π³ΡΠΈΠΏΠΏΠ° A (H1N1) Π½Π°Π±Π»ΡΠ΄Π°Π»Π°ΡΡ Π² 2015β2016 Π³Π³. ΠΈ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π΄ΠΎΠ»Π΅ΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΠΈ ΠΌΠΎΠΆΠ΅Ρ ΠΏΠΎΠ²ΡΠΎΡΠΈΡΡΡΡ Π² Π±ΡΠ΄ΡΡΠ΅ΠΌ. ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ Π΄Π°Π½Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΡΠΎΠΊΠ°Ρ ΡΠ°ΡΡΠΎΡΠ° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΠΈ ΡΡΠ΅Π΄ΠΈ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΆΠ΅Π½ΡΠΈΠ½. Π Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ ΠΈΠΌΠ΅ΡΡΡΡ ΡΠΎΠΎΠ±ΡΠ΅Π½ΠΈΡ ΠΎ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π²Π΅Π½ΠΎ%Π²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡ%ΠΆΠ΅Π»ΡΠΌ ΠΎΡΡΡΡΠΌ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠΌ Π΄ΠΈΡΡΡΠ΅ΡΡ-ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ, ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΌ ΠΊ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΡΠΌ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΡΠΌ. Π ΡΡΠ°ΡΡΠ΅ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅ΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΌΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΡΠΈΡΡΡΡΠ΅ΠΉ Π·Π°ΠΌΠ΅ΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΡΠΎΠ΄ΠΈΠ»ΡΠ½ΠΈΡΡ Ρ ΠΎΡΡΡΡΠΌ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠΌ Π΄ΠΈΡΡΡΠ΅ΡΡ-ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π½ΠΎΠΌ ΡΡΠΆΠ΅Π»ΠΎΠΉΒ Π²ΠΈΡΡΡΠ½ΠΎ-Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ Π½Π° ΡΠΎΠ½Π΅ Π³ΡΠΈΠΏΠΏΠ° Π (H1N1). ΠΠΎΠΊΠ°Π·Π°Π½Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ ΡΠΎΡΠ΅ΡΠ°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π²Π΅Π½ΠΎΠ²Π΅Π½ΠΎΠ·Π½ΠΎΠΉ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠΉ ΠΎΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΈΠΈ ΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π΄Π΅ΡΠΎΠΊΡΠΈΠΊΠ°ΡΠΈΠΈ. ΠΠ±ΠΎΠ·Π½Π°ΡΠ΅Π½Ρ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ°, Π²ΠΎΠ·Π½ΠΈΠΊΡΠΈΠ΅ ΠΊΠ°ΠΊ ΠΏΡΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ ΠΊ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π³Π°Π·ΠΎΠΎΠ±ΠΌΠ΅Π½Π°, ΡΠ°ΠΊ ΠΈ ΡΠ²ΡΠ·Π°Π½Π½ΡΠ΅ Ρ Π΅Π³ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ΠΌ Π² ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΈ, Π½Π΅ ΠΈΠΌΠ΅ΡΡΠ΅ΠΌ ΠΎΠΏΡΡΠ° ΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠ΅Π³ΠΎ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ½Π°ΡΠ΅Π½ΠΈΡ