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Кардиоваскулярная терапия и профилактика

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Факторы периоперационного сердечно-сосудистого риска и пути его снижения у больных ишемической болезнью сердца при чрескожных коронарных вмешательствах

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Аннотация

Такие перипроцедурные осложнения чрескожных коронарных вмешательств (ЧКВ), как инфаркт миокарда (ИМ), феномен “no-reflow/slow flow” и инсульт оказывают неблагоприятное влияние на отдаленную выживаемость. Это определяет необходимость оптимизации стратификации риска и профилактики их развития. Существующие подходы прогнозирования периоперационных осложнений ориентированы в основном на оценку вероятности смертельного исхода и не учитывают модифицируемые факторы риска, что ограничивает их значение рамками оценки пользы/риска ЧКВ. Назначение статинов в периоперационном периоде снижает риск перипроцедурного ИМ у больных стабильной стенокардией и при остром коронарном синдроме. Полагают, что такой благоприятный эффект обусловлен наличием у препарата противовоспалительных, антиокислительных, антитромботических, NO- и иммуномодулирующих свойств. Сведения о кардиопротективной перипроцедурной эффективности β-адреноблокаторов при ЧКВ неоднозначны. Данные о способности этих препаратов повышать риск развития феномена “slow flow”, спазма коронарных артерий, сердечной недостаточности и артериальной гипотонии делают необходимой оптимизацию пульс-урежающей составляющей фармакологического обеспечения процедуры ЧКВ. В качестве одного из перспективных подходов к решению этой проблемы может рассматриваться применение ивабрадина — препарата с доказанными антиишемическими и антиангинальными свойствами, не влияющего на сократительную способность миокарда и уровень артериального давления.

Об авторах

К. А. Назарова
ФГУ “Центральный Военный Клинический Госпиталь ФСБ России”. Москва
Россия
врач-кардиолог


О. В. Хилькевич
ФГУ “Центральный Военный Клинический Госпиталь ФСБ России”. Москва
Россия
врач-кардиолог


Г. К. Киякбаев
Российский университет дружбы народов
Россия
профессор кафедры факультетской терапии


Ж. Д. Кобалава
Российский университет дружбы народов
Россия
зав. кафедрой пропедевтики внутренних болезней


В. С. Моисеев
Российский университет дружбы народов
Россия
зав. кафедрой факультетской терапии


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Для цитирования:


Назарова К.А., Хилькевич О.В., Киякбаев Г.К., Кобалава Ж.Д., Моисеев В.С. Факторы периоперационного сердечно-сосудистого риска и пути его снижения у больных ишемической болезнью сердца при чрескожных коронарных вмешательствах. Кардиоваскулярная терапия и профилактика. 2010;9(8):86-95.

For citation:


Nazarova K.A., Khilkevich O.V., Kiyakbaev G.K., Kobalava Z.D., Moiseev V.S. Periinterventional cardiovascular risk and the methods for its reduction in coronary heart disease patients undergoing percutaneous coronary intervention. Cardiovascular Therapy and Prevention. 2010;9(8):86-95. (In Russ.)

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