ПРОФИЛАКТИКА ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ В КАРДИОХИРУРГИИ

Annually in the Russian Federation, as well as in other European countries and in the United States, the number of open-heart cardiac operations is increasing. However, despite the implementation of the latest technologies in cardiac surgery, the problem of infection remains highly actual. Infectious complications occurring in the postoperative period (nosocomial infections) have an adverse impact on its course and outcome, significantly worsening the results of surgical interferences and being additional, very significant item of expenses for inpatient hospital. Among nosocomial infections (NI) in patients of cardio surgical inpatient hospital nosocomial pneumonia (NP), surgical site infection (SSI), urinary tract infections (UTI), and sepsis are the most common.The present research provides the data on the risk factors of nosocomial infection and suggests the necessary preventive measures conducive to the reduction of infectious postoperative complications number and in-hospital mortality. It is noted that an important condition for prevention of nosocomial infections in all operations with artificial circulation is the mandatory compliance of full range of measures aimed at reducing the microbial burden, which must be observed at all stages of perioperative period.Ежегодно в Российской Федерации, как и в других странах Европы и в США, увеличивается количество кардиохирургических операций, проводимых на открытом сердце. Однако, несмотря на внедрение новейших технологий в кардиохирургии, проблема инфекции остается крайне актуальной.Инфекция, связанная с оказанием медицинской помощи (healthcare associated infection), а в частности инфекционные осложнения, возникающие в послеоперационном периоде (нозокомиальные, или внутрибольничные инфекции (ВБИ), оказывают неблагоприятное влияние на его течение и исход, существенно ухудшая результаты хирургических вмешательств и являясь дополнительной, весьма значимой статьей расходов для стационара. Среди ВБИ у пациентов кардиохирургического стационара наиболее часто встречаются внутрибольничная (нозокомиальная) пневмония (ВП), инфекции в области хирургического вмешательства (ИОХВ), мочевыводящих путей (ИМП) и сепсис.В данной публикации представлена информация о факторах риска внутрибольничной инфекции и обсуждены профилактические мероприятия, необходимые для снижения количества инфекционных послеоперационных осложнений и госпитальной летальности. Отмечено, что важным условием профилактики внутрибольничной инфекции при всех операциях является обязательное соблюдение полного комплекса мер, направленных на снижение микробной нагрузки, который должен соблюдаться на всех этапах периоперационного периода

НОЗОЛОГИЧЕСКАЯ СТРУКТУРА СМЕРТНОСТИ ОТ БОЛЕЗНЕЙ СИСТЕМЫ КРОВООБРАЩЕНИЯ в 2006 и 2013 годах

The article provides the results of the assessment of mortality parameters from circulatory system disease (CSD) in Russia in the period from 2006 to 2013. The comparative analysis of the nosological structure of causes of death from CSD was performed. Standardized mortality ratio from CSD decreased by 29,1 % in 2013 compared to 2006. Mortality rates caused by CSD prevail in total mortality rates, in particular in the >75 years age group, accounting for 70 % of all deaths. The vast number of deaths was caused by coronary artery disease, i. e. the cases that were not related to acute coronary events. Mortality rates after myocardial infarction (MI) have declined in all age groups < 80 years. Due to the increase in mortality rates after MI in the age groups > 80 years, there was no significant shift in mortality rates after MI in the total population. Recent amendments to the nosological coding of causes of death make difficult to perform the comparative assessment of mortality rates in a number of CSD. However, there was a significant number of deaths from SCD, which clinical interpretation is complicated by the current classification coding, thus, raising problems in the planning and organization of medical and social care, aimed at reducing mortality from SCD.В статье дана оценка показателей смертности от болезней системы кровообращения (БСК) в России в динамике с 2006 по 2013 г., проведен сравнительный анализ нозологической структуры причин смерти по данному классу заболеваний. Стандартизованный показатель смертности от БСК в 2013 г. снизился по сравнению с 2006 г. на 29,1 %. Доля смертей от БСК в структуре общей смертности высока, особенно в возрастных группах старше 75 лет, составляя около 70 % смертей от всех причин. Подавляющее число смертей от ишемической болезни сердца – это случаи, не связанные с острыми коронарными событиями. Смертность от инфаркта миокарда (ИМ) сократилась во всех возрастных группах моложе 80 лет, но, учитывая рост смертности от ИМ в возрастных группах старше 80 лет, существенной динамики показателей смертности от ИМ в популяции в целом, не выявлено. Сравнительная оценка показателей смертности по ряду заболеваний класса БСК затруднена в связи с внесением изменений в краткую номенклатуру причин смерти за текущий период. В структуре БСК как в 2006 г., так и в 2013 г. отмечается значительное число случаев смерти, текущая классификация которых вызывает проблемы с клинической интерпретацией, а следовательно, проблемы с планированием и организацией медико-социальной помощи, направленной на снижение смертности от БСК

The relationship of gene polymorphisms of C-reactive protein with the development of myocardial infarction and formation of multifocal atherosclerosis in CHD patients

Purpose. To assess the contribution of the CRP gene polymorphisms rs3093077, rs1130864 and rs1205 in the development of myocardial infarction (MI) and multivessel disease (MVD) in CAD patients based on gender and age. Material and methods. 303 patients with stable coronary artery disease were included in the study. C-reactive protein (CRP) levels were measured by high sensitive immunoturbidimetric assay. The genotyping studies were performed in 96-well plates using the TaqMan assay. Results. Male gender and older age are proven to be among independent clinical predictors of myocardial infarction and the development of MVD in patients with coronary artery disease. The rs1205 C/C CRP homozygous carriers have a significantly higher risk of multivessel coronary lesions at age > 65, regardless of gender (OR = 4.72, 95 % CI = 1.27–17.56; p = 0.045). The C/C genotype of rs3093077, A/G of rs1130864 and P/T of rs1205 in female patients reduce the risk of myocardial infarction (OR = 0.53, 95 % CI = 0.30–0.95; p = 0.0079, OR = 0.37, 95 % CI = 0.16 – 0.82; p = 0.0027 and OR = 0.35, 95 % CI = 0.14–0.84; p = 0.0097, respectively). The groups with and without myocardial infarction were comparable by the allele frequencies and genotype distribution combinations of the CRP polymorphisms (rs3093077, rs1130864 and rs1205). Regardless of a positive history of MVD and myocardial infarction, serum levels of CRP over 3 mg/L indicates a high risk of cardiovascular events in patients with stable coronary artery disease. However, there is no relationship between protein levels and the polymorphisms of the genes encoding them (p = 0.56). Conclusion: The prediction of myocardial infarction and MVD requires not only assessing clinical and demographic data of patients, but also measuring CRP levels and studying its gene polymorphisms

Dynamics of parameters of oxidative stress in blood of ischemic heart disease patients before and after coronary bypass surgery

Study the dynamics of oxidative stress in the blood of patients with ischemic heart disease before and after on-pump coronary bypass surgery. 27 ischemic heart disease patients were examined. Serum lipid peroxidation product concentrations, total antioxidant activity and α-tocopherol levels were measured. It has been found that lipid peroxidation product concentrations in the blood of ischemic heart disease patients increased significantly along with the decreased activity of antioxidant system. After coronary artery bypass surgery lipid peroxidation — antioxidant system imbalance worsens. The severity of the found impairments is closely related to the functional class of ischemic heart disease

THE RISK FACTORS AND EVALUATION CRITERIA FOR PROGRESSION OF ATHEROSCLEROSIS IN ONE YEAR POST CORONARY BYPASS

Aim. To assess risk factors and to compare evaluation criteria of non-coronary atherosclerosis progression in coronary heart disease patients in 1 year post coronary bypass surgery (CBG).Material and methods. Of 732 consequtive patients (586 males, 146 females, median age 59 y.o.) underwent CBG, 504 were investigated second time in 1 year after operation. Patients underwent ultrasound study (US) of carotid and peripheral arteries with measurement of intima-media thickness. Ankle-brachial index (ABI) was measured automatically with sphygmomanometer VaSeraVS-1000 (Fukuda Denshi,Japan). In blood, lipids were tested. Based on the stenosis indexes NASCET and ECST, the groups were selected: <30% (minor stenosis); 30-49% (moderate stenosis); 50-69% (severe stenosis); 70-99% (critical stenosis); occlusion; absence of stenoses. Criteria for progression of atherosclerosis was existence of at least one sign: transition of non-coronary stenosis from one group to another by US; decrease of ABI during 1 year below0,9 in normal baseline;  decrease of ABI >10% if the baseline ABI lower than 0,9. For analysis, two groups were selected: group 1 (n=375) without progression, and group 2 (n=129) with progression of atherosclerosis. The relation of possible factors to probaility of  on-coronary atherosclerosis progression was evaluated in logistic regression model.Results. Levels of the total cholesterol (TC) and low density lipoproteides cholesterol (LDL-C) were higher in patients with progression of atherosclerosis. In dynamics, significantly in both groups the level of high density lipoproteides cholestrol (HDL-C) increased (p<0,001), and triglycerides decreased (p<0,05). In intergroup analysis, ABI values were higher in the group with no progression of atherosclerosis (p<0,001). In dynamics, in the group of atherosclerosis progression there was significant ABI decrease (p<0,05). In non-progression group ABI, remaning in reference range, significantly decreased during a year after CBG (p<0,05). Thickness of CIM in the non-progression group significantly decreased during a year post-surgery, but in progression group the difference was non-significant. In monofactorial logistic regression, probability of atherosclerosis progression increased with the increase of age, in smoking anamnesis before surgery, in increase of TC and LDL-C, as with GFR decline and in baseline multifocal atherosclerosis presence. Multifactorial analysis showed remaining statistical significance for the several arterial regions, and adverse lipid profile.Conclusion. In one year post-CBG, progression of non-coronary atheroslerosis is marked in 25,6% of patients. In one year post-CBG, ABI decreases independently from the presence of non-coronary atherosclerosis. Factors associated with atherosclerosis progression, were multifocality, level of TC and LDL-C

THE ROLE OF C-REACTIVE PROTEIN AND POLYMORPHISMS OF ITS CANDIDATE GENES IN THE DEVELOPMENT OF IN-HOSPITAL CARDIOVASCULAR COMPLICATIONS IN PATIENTS AFTER CORONARY BYPASS SURGERY

Aim. To assess the prognostic significance of preoperation C-r.p. concentration and polymorphic site of the gene CRP (rs3093077, rs1130864, rs1205) for the development of early cardiovascular complications after direct myocardial revascularization.Material and methods. Totally 249 patients studied with CHD, underwent coronary bypass surgery (CBG). Concentration of C-r.p. was assessed with high-sensitive immune-turbidimetric method, genotyping was done by 96-hole format via TaqMan method, before CBG.Results. The risk of perioperational CVC increased in presence of such factors as age more than 65 y. o. (р=0,037), preoperational C-r.p. concentration higher than 5 mg/mL (р=0,026), homozygous genotype GG in promoter region of CRP gene (rs3093077) (c2 =9,08, р=0,0011) within all other conditions different (presence or absence of atrial fibrillation (AF), diabetes mellitus (DM) 2 type, duration of hypertension anamnesis (AH). In patients older than 65 y. o. the CVC risk increased almost 3 times: OR=2,8 (95% CI=1,07-7,34), and in serum concentrations of C-r.p. more than 5 mg/mL — two and a half times: OR=2,5 (95% CI=1,11-5,77). The carriage of genotype GG rs3093077 СRP increases the risk of CVC in in-hospital period of CBG for more than 2 times.Conclusion. For prediction of CVC in CBG it is necessary to evaluate not only clinical and anamnestic characteristics of a patient, but also the level of preoperation CRP, and genetic polymorphisms of their genes

Polymorphism of the apolipoprotein E gene in the population of the indigenous inhabitants of the Mountain Shoria and its association with the parameters of carbohydrate metabolism

Objective: we investigated apolipoprotein E gene polymorphism and its influence on a carbohydrate metabolism in native population of Mountain Shoria (West Siberia). Methods: The study included 40 men and 80 women aged 25-64. The apolipoprotein E polymorphism was analyzed by original method using Hixson’s approach. The serum glucose levels were determined by standard enzymatic assays. Results: The frequencies of ε2, ε3, ε4 alleles in men were 6.5 %, 80.4 %, 13.1 % and in women – 7.6 %, 72.6 %, 19.8 % respectively. The frequencies of genotypes ε2/ε4, ε2/ε3, ε3/ε3, ε3/ε4, ε4/ε4 in men and women together were 1.8 %, 12.4 %, 51.8 %, 31.2 % and 2.9 %. Mean fasting serum glucose levels in case of genotypes ε2/ε4, ε2/ε3, ε3/ε3, ε3/ε4 and ε4/ε4 were 4.6±0.3mg/dl, 4.6±0.1mg/dl, 4.0±0.1mg/dl, 4.7±0.1mg/dl, 5.8±0.3mg/dl (рGLM=0,000) in man and 4.7±0.3mg/dl, 4.7±0.1mg/dl, 4.1±0.1mg/dl, 4.9±0.1mg/dl, 5.9±0.2mg/dl in women (рGLM=0,000). After glucose tolerance test mean serum glucose levels in case of genotypes ε2/ε4, ε2/ε3, ε3/ε3, ε3/ε4 and ε4/ε4 were 6.0±0.6mg/dl, 6.1±0.3mg/dl, 5.2±0.2mg/dl, 6.4±0.2mg/dl, 8.4±0.5mg/dl (рGLM=0,000) in man and 6.2±0.6mg/dl, 6.1±0.2mg/dl, 5.5±0.1mg/dl, 6.7±0.1mg/dl, 8.6±0.5mg/dl (рGLM=0,000) in women. Conclusions: The native population of Mountain Shoria is characterized by relatively high frequencies of ε4 alleles. The allele ε4 prevails in women. The genotype ε4/ε4 has been associated with higher serum glucose level