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Acta chirurgica iugoslavica 2011, vol. 58, br. 2, str. 39-43
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Preoperativna priprema bolesnika sa kardiomiopatijama u nekardijalnoj hirurgiji
aCenter for Anesthesiology, Clinical Center of Serbia, Belgrade
bSchool of Medicine, Belgrade + Clinic for Cardiology, Clinical Center of Serbia, Belgrade
cSchool of Medicine, Belgrade + University Children's Hospital, Belgrade
dKlinički centar Niš
eCenter for Anesthesiology, Clinical Center of Serbia, Belgrade + School of Medicine, Belgrade
SažetakKardiomiopatije su oboljenja miokarda kod kojih postoji strukturni i funkcionalni poremećaj srčanog mišića, u odsustvu oboljenja koronarnih arterija, hipertenzije, valvularne bolesti i urođene srčane bolesti. Kardiomiopatije su grupisane u specifične morfološke i funkcionalne fenotipove: dilatativna kardiomiopatija, hipertrofična kardiomiopatija, restriktivna kardiomiopatija, aritmogena kardiomiopatija desne komore i neklasifikovane kardiomiopatije. Pacijenti sa dilatativnom i hipertrofičnom kardiomiopatijom su skloni nastanku kongestivne srčane insuficijencije u perioperativnom periodu. Takođe, pacijenti sa hipertrofičnom i aritmogenom kardiomiopatijom desne komore su skloni poremećajima ritma u perioperativnom periodu. Preoperativna evaluacija uključuje anamnezu, fizikalni pregled, EKG, radiografiju grudnog koša, krvnu sliku, elektrolite, kreatinin, brzinu glomerularne filtracije, glikemiju, hepatogram, analizu urina, BNP i ehokardiografsku evaluaciju funkcije leve komore. Medikamentoznu terapiju bi trebalo optimizovati i nastaviti preoperativo. Operaciju treba odložiti (osim ako je hitna) kod pacijenata sa dekompenzovanom ili nelečenom kardiomiopatijom. Preoperativna evaluacija zahteva integrisani multidisciplinarni pristup anesteziologa, kardiologa i hirurga.
Ključne reči
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