članak: 1 od 1  
Srpski arhiv za celokupno lekarstvo
2005, vol. 133, br. 9-10, str. 406-411
jezik rada: srpski
članak
doi:10.2298/SARH0510406V

Hirurška revaskularizacija miokarda kod bolesnika s hroničnom ishemijskom kardiomiopatijom i ejekcionom frakcijom leve komore manjom od trideset posto
aUniverzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije
bUniverzitet u Beogradu, Medicinski fakultet, Institut za zdravstvenu zaštitu majke i deteta Republike Srbije 'Dr Vukan Čupić'

e-adresa: velinovic@verat.net

Sažetak

Uvod Bolesnici s hroničnom ishemijskom kardiomiopagijom i ejekcioiom frakcijomleve komore (EFLK) manjom od trideset posto predstavljaju tešku i kontroverznu grupu bolesnika oko čijeg lečenja postoje još nerazjašnjena pitanja. Cilj rada Cilj rada je bio da se ispita efekat hirurškog lečenja na rano i kasno preživljavanje bolesnika s hroničnom ishemijskom kardiomiopatijom i ejekcionom frakcijom leve komore manjom od trideset posto. Metod rada U periodu od 1995. do 2000. godine hirurški je lečeno 50 bolesnika sa EFLK<30%(78%bolesnika muškog pola, prosečne starosti od 58,3 godine;raspon 42-75). U ovu grupu nisu svrstani bolesnici kod kojih je dijagnostikovana aneurizma leve komore ili insuficijekcija mitralne valvule. Kao parametri hemodinamskog statusa leve komore uzimani su ehokardiografski indikatori: EFLK, frakcija skraćenja (FS), sistolni i dijastolni dijametri (MDD, LVESD) i volumeni leve komore (LVEDV, LVESV), kao i njihove indeksirane vrednosti (LVESVI). Rezultati Od50hirurški lečenih i nadgledanih bolesnika umrlo je 15.Dva bolesnika su umrla tokom operacije.Utvrđeno je da između dijabetes melitusa, preležanog infarkta miokarda, stenoze glavnog stabla leve koronarne arterije, trosudovne koronarne bolesti i rezultata ishoda operacije postoji statistički značajna korelacija. Između godina starosti, pozitivne porodične anamneze,pušenja,hipertenzije,hiperlipidemije,preležanog cerebroeaskularnog insulta,periferne vaskularne bolesti, slabosti bubrega i rezultata ishoda hirurškog lečenja ne postoji statistički značajna povezanost. Poređenjem ehokardiografskih indikatora pre operacije između preživelih i umrlih bolesnika dobijeni rezultati pokazuju da postoji statistički značajna razlika u indikatorima EFLK, FS, LVEDD, LVESD, LVEDV, LVESV, LVESVI kod bolesnika koji jesu i koji nisu preživeli operaciju (p<0,01, osim za FS, gde je p=0,419). Preoperaciono LVESVI je imao najveću prediktivnu moć (R=0,595). Zaključak Rezultati našeg istraživanja su pokazali da su dijabetes melitus,preležan infarkt miokarda,stekoza glavnog stabla i trosudovna koronarna bolest značajni faktori rizika za nastanak smrti bolesnika tokom operacije. Vrednost EFLK, FS, sistolnih i dijastolnih dijametara i volumena leve komore kao i njihove indeksirane vrednosti su značajno bolji u postoperacionom periodu u odnosu na preoperacioni period kod preživelih bolesnika.Ovi ehokardiografski indikatori su takođe značajni prediktori mortaliteta, a najveću prediktivnu vrednost ima LVESVI.

Ključne reči

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