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«Клиническая физиология кровообращения»

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ISSN 2410-9134 (Online)

 

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Каталог статей ➤ КФК. 2025; 22 (3): 199-286 ➤ Алгоритм действий при осложнениях дренирования спинномозговой жидкости во время операций на аорте

Алгоритм действий при осложнениях дренирования спинномозговой жидкости во время операций на аорте

Авторы: Щаницын И.Н., Аракелян В.С., Папиташвили В.Г., Аверина Т.Б., Бондарев А.М., Букацелло Р.Г., Куличков П.П., Андронатий В.А.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2025-22-3-222-235

УДК: 616.13-004.6-089

Библиографическая ссылка: Клиническая физиология кровообращения. 2025; 22 (3): 222-235

Цитировать как: Щаницын И.Н., Аракелян В.С., Папиташвили В.Г., Аверина Т.Б., Бондарев А.М., Букацелло Р.Г., Куличков П.П., Андронатий В.А.. Алгоритм действий при осложнениях дренирования спинномозговой жидкости во время операций на аорте. Клиническая физиология кровообращения. 2025; 22 (3): 222-235. DOI: 10.24022/1814-6910-2025-22-3-222-235

Ключевые слова: аневризма торакоабдоминального отдела аорты, ликвор, дренирование спинномозговой жидкости, осложнения, внутричерепное кровоизлияние

Поступила / Принята к печати:  01.09.2025 / 15.09.2025

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Аннотация

В настоящее время при открытых и эндоваскулярных операциях на грудном отделе аорты рекомендуется профилактическое дренирование спинномозговой жидкости (СМЖ) у пациентов высокого риска ишемии спинного мозга. Однако в последние годы отмечается рост числа публикаций с описанием тяжелых осложнений дренирования СМЖ, такими как субдуральная гематома или внутримозговое кровоизлияние. Частота всех осложнений в ряде исследований достигает 10%. Целью данной работы был анализ существующих исследований и собственного опыта для создания алгоритма действий при возникновении различных осложнений дренирования СМЖ. 

Методы. Мы провели обзор литературы, посвященной осложнениям дренирования СМЖ при операциях на аорте. Осложнения были систематизированы по степени тяжести, и была определена средняя частота развития осложнений по данным литературы. Проведен анализ собственных результатов лечения пациентов с аневризмами грудного (АГА) и торакоабдоминального отделов аорты (ТААА) с 2000 по 2024 гг., которым проводили мониторирование давления СМЖ и дренирование. В ретроспективное исследование вошли 331 пациент с диагнозом АГА (50,8%) и ТААА (49,2%). Оценивали частоту осложнений дренирования СМЖ и летальность, связанную с дренированием СМЖ.

Результаты. В ретроспективном исследовании осложнения дренирования СМЖ были выявлены в 11,2% случаев. По степени тяжести осложнений разделение было следующим: легкие – в 5,1% случаев (умеренные постпункционные головные боли – ППГБ), средней тяжести – в 3,3% (выраженные ППГБ – 1,8%, асимптомное внутримозговое кровоизлияние – 1,2%, признаки паралюмбальной инфекции – 0,3%), тяжелые – в 2,7% (симптомная субдуральная гематома – 1,2%, внутримозговое кровоизлияние – 1,5%). Трудности при постановке спинального дренажа отмечены в 2,1% случаев. Кровь в ликворе выявлена у 1,5% пациентов. Летальность, связанная с осложнением дренирования СМЖ, составила 2,4%. Тяжелые осложнения (симптомная субдуральная гематома и внутримозговое кровоизлияние) выявлены у 2,7% пациентов. При сравнении с данными литературы частота тяжелых осложнений не отличалась, однако общая частота осложнений оказалась выше, в первую очередь за счет легких осложнений.

Основываясь на данных литературы и собственном опыте, нами был разработан подробный алгоритм действий при возникновении различных осложнений дренирования СМЖ.

Заключение. Несмотря на то что дренирование СМЖ остается основным методом профилактики и лечения ишемии спинного мозга при операциях по поводу ТААА, необходимо оценивать потенциальный риск и пользу дренирования. Алгоритм действий при возникновении различных осложнений дренирования СМЖ позволит снизить частоту неблагоприятных исходов при операциях на аорте.

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Об авторах

  • Щаницын Иван Николаевич, канд. мед. наук, науч. сотр., врач – сердечно-сосудистый хирург; ORCID
  • Аракелян Валерий Сергеевич, д-р мед. наук, профессор кафедры, руководитель отдела артериальной патологии, врач сердечно-сосудистый хирург; ORCID
  • Папиташвили Васил Георгиевич, д-р мед. наук, врач – сердечно-сосудистый хирург; ORCID
  • Аверина Татьяна Борисовна, канд. мед. наук, врач – анестезиолог-реаниматолог; ORCID
  • Бондарев Алексей Михайлович, врач – анестезиолог-реаниматолог; ORCID
  • Букацелло Роман Георгиевич, канд. мед. наук, ст. науч. сотр., врач – сердечно-сосудистый хирург; ORCID
  • Куличков Павел Павлович, науч. сотр., врач – сердечно-сосудистый хирург; ORCID
  • Андронатий Виктория Александровна, ординатор; ORCID

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