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«Клиническая физиология кровообращения»

Главный редактор

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


Инфузионные растворы, применяемые при операциях аортокоронарного шунтирования

Авторы: Хинчагов Д.Я., Рыбка М.М.

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/10.24022/1814-6910-2022-19-2-119-126

УДК: 616.12-005.4-036.12-089.86:615.355

Библиографическая ссылка: Клиническая физиология кровообращения. 2022; 2 (19): 119-126

Цитировать как: Хинчагов Д.Я., Рыбка М.М. . Инфузионные растворы, применяемые при операциях аортокоронарного шунтирования. Клиническая физиология кровообращения. 2022; 2 (19): 119-126. DOI: 10.24022/1814-6910-2022-19-2-119-126

Ключевые слова: аортокоронарное шунтирование, инфузионные растворы, послеоперационные осложнения

Поступила / Принята к печати:  30.07.2021 / 28.02.2022

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Аннотация

Инфузионная терапия – один из важнейших компонентов анестезиологического обеспечения операций аортокоронарного шунтирования. Адекватное возмещение внутрисосудистого объема является решающим фактором, влияющим на результаты хирургических вмешательств. При этом существенное значение имеет не только объем инфузии, но и состав инфузионных растворов. В настоящее время для инфузионной терапии применяются сбалансированные кристаллоидные растворы или комбинация сбалансированных кристаллоидных растворов с желатином или альбумином. Выбор применяемых растворов для проведения инфузионной терапии может повлиять на частоту послеоперационных осложнений.

В данной статье приведены сведения об основных инфузионных растворах, используемых в настоящее время при операциях аортокоронарного шунтирования. Проанализированы их преимущества и недостатки, влияние на гемодинамику, систему гемостаза, величину кровопотери, потребность в гемотрансфузии и в конечном итоге на результаты лечения.

Литература

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****
  1. Miller T.E., Myles P.S. Perioperative fluid therapy for major surgery. Anesthesiology. 2019; 130: 825–32. DOI: 10.1097/ALN.0000000000002603
  2. Cherniy V.I. The role and place of albumin in modern infusion-transfusion therapy. Emergency Medicine. 2017; 1 (80): 23–31 (in Russ.). DOI: 10.22141/2224-0586.1. 80.2017.94448
  3. Romagnoli S., Rizza A., Ricci Z. Fluid status assessment and management during the perioperative phase in adult cardiac surgery patients. J. Cardiothorac Vasc. Anesth. 2016; 30 (4): 1076–84. DOI: 10.1053/j.jvca.2015.11.008
  4. Feldheiser A., Pavlova V., Bonomo T., Jones A., Fotopoulou C., Sehouli Jet al. Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm. Br. J. Anaesth. 2013; 110 (2): 231–40. DOI: 10.1093/bja/aes377
  5. Lobo D.N., Stanga Z., Aloysius M.M., Wicks C., Nunes Q.M., Ingram K.L. et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit. Care Med. 2010; 38 (2): 464–70. DOI: 10.1097/CCM.0b013e3181bc80f1
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  8. Mitra S., Khandelwal P. Are all colloids same? How to select the right colloid? Indian J. Anaesth. 2009; 53: 592–607. PMID: 20640110
  9. Muller L., Le Frant J.Y. Metabolic effects of plasma expanders. Transf. Alt. Transf. Med. 2010; 11 (3): 10–21. DOI: 10.1111/j.1778-428X.2010.01137
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  17. Hilbert-Carius P., Schwarzkopf D., Reinhart K., Hartog C.S., Lefering R., Bernhard M., Struck M.F. Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU). Scientific Reports. 2018; 8: 11567. DOI: 10.1038/s41598-018-30053-0
  18. Finfer S., Liu B., Taylor C., Bellomo R., Billot L., Cook D. et al.; SAFE TRIPS Investigators. Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit. Care. 2010; 14: 185. DOI: 10.1186/cc9293
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  21. Leberle R., Ernstberger A., Loibl M., Merkl J., Bunz M., Creutzenberg M. et al. Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients. Injury. 2015; 46 (1): 105–9. DOI: 10.1016/j.injury.2014.08.039
  22. Rasmussen K.C., Secher N.H., Pedersen T. Effect of perioperative crystalloid or colloid fluid therapy on hemorrhage, coagulation competence, and outcome: a systematic review and stratified meta-analysis. Medicine (Baltimore). 2016; 95 (31): 4498. DOI: 10.1097/MD.0000000000004498
  23. Kozek-Langenecker S.A. Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology. 2005; 103: 654–60. DOI: DOI: 10.1097/00000542-200509000-00031
  24. Bayer O., Schwarzkopf D., Doenst T., Cook D., Kabisch B., Schelenz C. et al. Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery – a prospective sequential analysis. Crit. Care Med. 2013; 41: 2532–42. DOI: 10.1097/CCM.0b013e3182978fb6 26.
  25. Moeller C., Fleischmann C., Thomas-Rueddel D., Vlasakov V., Rochwerg B., Theurer P. et al. How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J. Crit. Care. 2016; 35: 75–83. DOI: 10.1016/j.jcrc.2016.04.011
  26. Farooque S., Kenny M., Marshall S.D. Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. Anaesthesia. 2019; 74 (2): 174–9. DOI: 10.1111/anae.14497
  27. Mårtensson J., Bellomo R. Are all fluids bad for the kidney? Curr. Opin. Crit. Care. 2015; 21: 292–301. 126 Reviews Clinical Physiology of Circulation. 2022; 19 (2). DOI: 10.24022/1814-6910-2022-19-2-119-126
  28. Pisano A., Landoni G., Bellomo R. The risk of infusing gelatin? Die-hard misconceptions and forgotten (or ignored) truths. Minerva Anestesiol. 2016; 82 (10): 1107–14. PMID: 27045639
  29. Food and drug administration. List of drug products that have been withdrawn or removed from the market for reasons of safety or effectiveness. 63 FR 54082. 1998. Available at: https://www.gpo.gov/fdsys/pkg/FR-1998- 10-08/pdf/98-26923.pdf (accessed 30.06.2021)
  30. Moman R.N., Gupta N., Varacallo M. Physiology, albumin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. PMID: 29083605
  31. Clarke G., Yan M. Clinical guide to transfusion. Chapter 3. Albumin. Canadian Blood Services. 2018. Available at: https://professionaleducation.blood.ca/en/transfusion/guide-clinique/albumin (accessed June 2021) 33. Martenssona J., Bellomoa R. Are all fluids bad for the kidney? Curr. Opin. Crit. Care. 2015; 21 (4): 292–301. DOI: 10.1097/MCC.0000000000000214
  32. Moret E., Jacob M.W., Ranucci M., Schramko A.A. Albumin – beyond fluid replacement in cardiopulmonary bypass surgery: why, how, and when? Sem. Cardiothorac. Vasc. Anesth. 2014; 18 (3): 252–9. DOI: 10.1177/1089253214535667
  33. Vlasov H., Juvonen T., Hiippala S., Suojaranta R., Peltonen M., Schramko A. et al. Effect and safety of 4% albumin in the treatment of cardiac surgery patients: study protocol for the randomized, double-blind, clinical ALBICS (ALBumin In Cardiac Surgery) trial. Trials. 2020; 21 (1): 235. DOI: 10.1186/s13063-020- 4160-3
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Об авторах

  • Хинчагов Джумбер Яковлевич, канд. мед. наук, врач – анестезиолог-реаниматолог; ORCID
  • Рыбка Михаил Михайлович, д-р мед. наук, заместитель директора по анестезиологии и реанимации, заведующий отделом анестезиологии, реанимации и интенсивной терапии; ORCID

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