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КЛИНИЧЕСКАЯ МЕДИЦИНА КАЗАХСТАНА №3,4 (22,23) 2011
TRANSFUSIONS DURING CARDIOPULMONARY BYPASS: TRIGGERED BY VENOUS
OXYGEN SATURATION
Zhanturganov M., Albazarov A., Mendykulov S., Altenov K., Isanov A., Tojiboyev R.
National Scientific Medical Research Center, Astana, Kazakhstan
During cardiopulmonary bypass (CPB), red blood cell transfusions may be required to correct dilutional anemia. The decision-making process for transfusions is usually based on the level of hemoglobinThis study investigates the hypothesis that oxygen-derived variables (mixed venous oxygen saturation, SvO (2) may be more reliable predictor of the efficacy of the transfusion. Thirty-four patients for 41 transfusion episodes during CPB were retrospectively analyzed. For each patient, oxygen-derived variable, including SvO (2) was measured before and after the transfusion. No changes in pump flow were allowed between the two measurements. The efficacy of transfusion was defined as an increase in SvO (2) of at least 5%. We identified 10 transfusion episodes leading to an efficacious SvO (2) increase.No association was found with hemoglobin values, unless for a trend for efficacy of transfusion in patients with very low (<6 g/dL) hemoglobin values. Cut-off values of 63% for SvO(2) was predictive for the efficacy of red blood cell transfusions.In conclusion, SvO(2) better than the hemoglobin value for guiding the decision-making process of red blood cell transfusions to correct hemodilutional anemia during CPB.
ROUTINE PLACEMENT OF NASOGASTRIC TUBES AFTER CARDIAC SURGERY AND POSTOPERATIVE NAUSEA AND VOMITING
Tojiboyev R., Konakbay B.
National Scientific Medical Research Center, Astana, Kazakhstan
Background: Incidence of postoperative nausea and vomiting (PONV) after cardiac surgery is 30-40%. The role of nasogastric tube (NGT) in reduction of PONV is still controversial.
Objectives: The purpose of this study is to assess the impact of NGT placement on PONV in patients undergoing cardiacsurgery.
Methods: After informed consent, 85 patients undergoing cardiac surgery with cardiopulmonary bypass were randomized to either receive NGT after induction of anesthesia (Group NGT) or to the controlgroup (no NGT). Patients with history of gastro/duodenal ulcer, gastric/esophageal surgery, and/or history of antiemetic treatment were excluded. Standard cardiac anesthesia and postoperative care were employed for all patients. Incidence of PONV was recorded hourly for first 4 hours after extubation and every 4hours afterwards for 24hours. Usage of antiemetics and pain medication were also recorded. Data were analyzed with t-test.
Results: The groups were similar with respect to demographic data, surgical characteristics, and opioid usage. There was no significant difference in the incidence of PONV and the antiemetic usage between the two groups.
Discussion: This study showed that placement of NGT did not impact on the incidence of PONV or requirements for antiemetics after cardiac surgery. The results of this study do not support the routine use of NGT to reduce PONV after cardiac surgery.
ИННОВАЦИИ В ЛЕЧЕНИИ БОЛЬНЫХ СО СТАБИЛЬНОЙ СТЕНОКАРДИЕЙ
Кусымжанова Ж.М.
Центральная клиническая больница УДП РК, Алматы, Казахстан
В Европе и России накоплен большой фактический материал, свидетельствующий о центральной роли уровня частоты сердечных сокращений (ЧСС) в патогенезе стабильной стенокардии. Высокая ЧСС - это непрямое повреждение сосудов и провакация развития атеросклероза, что одновременно и повышает потребность миокарда в кислороде, и дестабилизирует атеросклеротические бляшки, повышая вероятность разрыва их покрова. Это в конечном итоге приводит к развитию таких сердечно-сосудистых осложнений, как внезапная коронарная смерть и инфаркт миокарда. Помимо неблагоприятного влияния на уровень смертности высокая ЧСС является независимым фактором риска прогрессирования ИБС. В эпидемиологическом исследовании REALITY, проведенном в Казахстане, выявлено, что из 508 пациентов с ИБС, стабильной стенокардией - 87% больных на фоне проводимого лечения не имели оптимальный уровень ЧСС в покое, 88% больных на фоне проводимого лечения отмечались приступы стенокардии.
Кораксан (ивабрадин) - инновационный препарат, который селективно ингибирует If- каналы в клетках синусового узла и снижает ЧСС, не влияя на другие показатели сердечной деятельности.
Цель. Изучить эфффективность Кораксана у больных с верифицированным диагнозом стабильной стенокардии.
НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ
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