cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-5-77-81cardiovascular-1943Research ArticleРАЗНОЕПрименение заместительной почечной терапии в лечении и профилактике контраст-индуцированной нефропатии после операций на сердце и сосудахRenal replacement therapy in the treatment and prevention of contrastinduced nephropathy after cardiovascular surgeryТабакьянЕ. А.TabakyanE. A.

н.с. отдела сердечно-сосудистой хирургии

Москва, Тел.: (495) 414-65-49, факс: (495) 414-66-99

tabakyan@mail.ruКомлевА. Е.KomlevA. E.

врач-кардиолог отдела

Москва

МарголинаА. А.MargolinaA. A.

с.н.с. отдела

Москва

АкчуринР. С.AkchurinR. S.

руководитель отдела

Москва

Институт клинической кардиологии им. А.Л. Мясникова ФГУ Российского кардиологического научнопроизводственного комплекса Министерства здравоохранения и социального развития РФA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Centre2011201020111057781Copyright © Табакьян Е.А., Комлев А.Е., Марголина А.А., Акчурин Р.С., 20112011Табакьян Е.А., Комлев А.Е., Марголина А.А., Акчурин Р.С.Tabakyan E.A., Komlev A.E., Margolina A.A., Akchurin R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1943

Цель. Проанализировать эффективность применения гемофильтрации (ГФ) и высокопоточного гемодиализа (ВГД) для предупреждения и лечения острой почечной недостаточности (ОПН) после операций на сердце с использованием контрастных веществ (КВ). Материал и методы. Пациентам выполняли различные операции на сердце. С целью визуализации использовали низкоосмолярные КВ: ультравист, оптирей и изоосмолярные — визипак. Риск развития контраст-индуцированной нефропатии (КИН) оценивали по рекомендациям Barrett ВJ, Parfrey PS, 2006. Процедуры ГФ и ВГД в режиме рециркуляции диализата проводили на аппарате Diapact®CRRT; использовали замещающий раствор Duosol®. Антикоагуляция — гепарином под контролем активированного времени свертывания. Контроль гематокрита, содержания калия и натрия, глюкозы, рН, бикарбоната, лактата в венозной крови, каждые 2-3 ч процедуры. Результаты. Процедуры заместительной почечной терапии (ЗПТ) проводили у 5 больных после развития ОПН III ст. У двух из них имела место ОПН и полиорганная недостаточность (ПОН). Летальный исход наблюдали в одном случае, в 4 — отмечали обратное развитие ОПН, восстановление функции почек. В одном случае ПОН, гипербилирубинемии, гиперферментемии проводили ГФ и плазмаферез. У 2 больных с очень высоким риском развития ОПН ГФ и ВГД выполняли профилактически, непосредственно после операций на сердце. Значимого снижения скорости клубочковой фильтрации (СКФ), развития ОПН, после профилактического применения ЗПТ не наблюдали. Заключение. В случаях развития КИН, ОПН после ангиопластики и гибридных операций на сердце с ведением КВ применение ЗПТ эффективно устраняет угрожающие жизни метаболические нарушения, обусловленные ОПН. У больных очень высокого риска развития КИН применение ЗПТ непосредственно после операций с введением КВ предупреждает значимое снижение СКФ, развитие ОПН.

Aim

Aim. To analyse the effectiveness of hemofiltration and high-volume hemodialysis for acute renal failure (ARF) prevention and treatment after cardiovascular surgery and contrast media (CM) use. Material and methods. The patients cardiovascular jurgery. For cardiovascular visualisation, low-osmolar or isoosmolar CM were used (ultravist, optiray and visipack, respectively). The risk of contrast-induced nephropathy (CIN) was assessed, according to the guidelines by Barrett ВJ, Parfrey PS (2006). Hemofiltration and high-volume hemodialysis (recirculating dialysate regimen) were performed with the Diapact®CRRT device, using the Duosol® solution. Heparin anticoagulation was monitored by activated coagulation time. Every 2-3 hours, the levels of hematocrit, potassium, sodium, glucose, pH, bicarbonate, and lactate in venous blood were measured. Results. Renal replacement therapy (RRT) procedures were performed in 5 patients after Stage III ARF development. In two cases, ARF was combined with multi-organ failure (MOF). In one case, ARF resulted in death, and in four other cases, ARF regressed with renal function normalisation. In one case of MOF, hyperbilirubinemia, and hyperenzymemia, hemofiltration was combined with plasmapheresis. In two patients with a very high ARF risk, hemofiltration and high-volume hemodialysis were performed preventatively, after cardiac surgery. Preventive RRT was not associated with a significant reduction in glomerular filtration rate (GFR) or with ARF development.

Conclusion

Conclusion. In patients with CIN and ARF after CM use during angioplasty and hybrid cardiac surgery, RRT effectively reduces life-threatening metabolic complications of ARF. Among individuals with a very high ARF risk, RRT immediately after CM-using cardiovascular surgery can prevent a significant GFR reduction and ARF development.

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The authors declare that there are no conflicts of interest present.