članak: 1 od 1  
Srpski arhiv za celokupno lekarstvo
2011, vol. 139, br. 7-8, str. 452-457
jezik rada: srpski
originalan članak
doi:10.2298/SARH1108452P

Hirurška revaskularizacija miokarda na kucajućem srcu kod bolesnika s lošom funkcijom leve komore
aKlinika za kardiohirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd
bUniverzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije
cMedicinski fakultet, Beograd + Klinika za fizikalnu medicinu, Klinički centar Srbije, Beograd

e-adresa: svetozar073@yahoo.com

Projekat Ministarstva nauke Republike Srbije, br. 41002

Sažetak

Uvod. Poseban izazov u koronarnoj hirurgiji jesu bolesnici s niskom ejekcionom frakcijom (EF). Operacija koronarnih arterija na kucajućem srcu mogla bi biti metoda izbora u lečenju ovih bolesnika. Cilj rada. Cilj rada je bio da se utvrdi prednost hirurške revaskularizacije miokarda bez upotrebe vantelesnog krvotoka kod bolesnika sa EF manjom od 30% nad konvencionalnom hirurškom procedurom. Metode rada. Između juna 2004. i marta 2006. godine u Klinici za kardiohirurgiju Kliničkog centra Srbije u Beogradu operisano je 60 bolesnika sa EF manjom od 30%. Bolesnici su metodom slučajnog izbora svrstani u dve grupe od po 30 bolesnika. Rezultati. Bolesnici prve grupe u proseku su imali 59,2 godine i kod njih su urađene prosečno 2,30 distalne anastomoze uz primenu vantelesnog krvotoka. Ispitanici druge grupe u proseku su bili stari 59,6 godina, a kod njih su urađene prosečno 2,03 distalne anastomoze na kucajućem srcu. U odnosu na ispitanike prve grupe, kod bolesnika kod kojih je operacija izvedena na kucajućem srcu vrednosti troponina I u ranom postoperacionom toku bile su značajno niže (0,71 prema 3,0 μ/l). Takođe, značajno je manja bila potreba za inotropnom potporom u neposrednom postoperacionom toku, dat je manji broj transfundovanih jedinica krvi, a boravak na odeljenju intenzivne nege trajao je kraće, kao i celokupno bolničko lečenje. Razlika u ukupnom broju komplikacija, u učestalosti atrijalne fibrilacije i preživljavanju bolesnika nakon operacije izvedene na kucajućem srcu i klasičnim pristupom nije dostigla statističku značajnost. Zaključak. Hirurški zahvat na kucajućem srcu, u poređenju s konvencionalnim hirurškim lečenjem, omogućava sličan broj distalnih anastomoza, manji stepen intraoperacionog oštećenja miokarda, smanjenje potrebe za transfuzijama, kraću hospitalizaciju, sličnu stopu mortaliteta i sličnu učestalost komplikacija nakon operacije.

Ključne reči

koronarna hirurgija; kucajuće srce; ishemijska miokardiopatija

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