cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2021.4.n1596cardio-1596Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESАнемия как фактор риска дисфункции внутренних органов у больных, оперируемых по поводу приобретенных пороков сердцаAnemia as a Risk Factor for Organ Dysfunctions in Patients Operated on Heart ValvesЮдинГ. В.YudinG. V.

к.м.н., врач анестезиолог-реаниматолог отделения анестезиологии-реанимации

Cand. Med. Sc., Anesthesiologist-Intensivist

yudingv@rambler.ruРыбкаМ. М.RybkaM. M.

заместитель директора по анестезиологии и реанимации, д.м.н., руководитель отделения анестезиологии-реанимации

Deputy Director for Anesthesiology and  intensive care, Chief of Department of Anesthesiology

rybkamikh@mail.ruХинчаговД. Я.KhinchagovD. Ya.

к.м.н., врач анестезиолог-реаниматолог отделения анестезиологии-реанимации

Cand. Med. Sc., Anesthesiologist-Intensivis

khinch@mail.ruДибинД. А.DibinD. A.

врач анестезиолог-реаниматолог отделения анестезиологии-реанимации

Anesthesiologist-Intensivist

dadibin@bakulev.ruГончаровА. А.GoncharovA. A.

врач анестезиолог-реаниматолог отделения анестезиологии-реанимации

Anesthesiologist-Intensivist

goncharov141290@mail.ruФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А. Н. Бакулева» Минздрава России, МоскваРоссияBakoulev National Medical Research Center for Cardiovascular Surgery, MoscowRussian Federation2021040520216143945Copyright © Kardiomag, 20212021KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1596

Цель    Изучение влияния пред- и послеоперационной анемии на риск развития и структуру дисфункции внутренних органов у больных, оперируемых по поводу приобретенных пороков сердца (ППС).

Материал и методы  Ретроспективное когортное исследование, включающее 610 первично оперированных больных с ППС. Проводились сравнительный анализ частоты развития и структуры дисфункции внутренних органов, а также определение вероятности интраоперационной гемотрансфузии у пациентов в группах предоперационной анемии (гемоглобин <130 г / л) и отсутствия анемии. Осуществлялась сравнительная оценка частоты развития и характера повреждения внутренних органов у больных в группах с концентрацией гемоглобина после операции менее 90 г / л и послеоперационным уровнем гемоглобина 90–130 г / л.

Результаты   Наличие предоперационной анемии, выявленной у 45 % пациентов, увеличивало риск развития острой сердечной недостаточности на 2‑е сутки после операции в 6 раз (отношение шансов [ОШ] 5,75; 95 % доверительный интервал [ДИ] 1,23–26,84; р=0,016), полиорганной недостаточности (ПОН) – в 4 раза (ОШ 4,2; 95 % ДИ 1,16–15,64; р=0,03), вероятность гемотрансфузии – в 5 раз (ОШ 4,74; 95 % ДИ 3,12–7,19; р<0,0001). Анемия средней и тяжелой степени (гемоглобин <90 г / л) наблюдалась у 11,2 % пациентов, наличие которой повышало риск развития дисфункции головного мозга (ОШ 5,72; 95 % ДИ 2,17–15,06; р=0,001) и ПОН (ОШ 5,97; 95 % ДИ 1,94–18,35; р=0,004) в 6 раз по сравнению с таковым при уровне гемоглобина 90–130 г / л.

Заключение     У больных с ППС предоперационная анемия увеличивает риск декомпенсации кровообращения на 2‑е сутки после операции и развития ПОН, а также повышает вероятность интраоперационной гемотрансфузии; послеоперационная анемия с уровнем гемоглобина в крови <90 г / л увеличивает риск повреждения головного мозга и ПОН.

Aim      To study the effects of pre- and postoperative anemia on the risk and the structure of internal organ dysfunction in patients undergoing surgery for acquired heart diseases (AHD).

Material and methods  This was a retrospective cohort study including 610 primarily operated patients with AHD. A comparative analysis of the incidence and the structure of internal organ dysfunction was performed, and the likelihood of intraoperative hemotransfusion was determined for patients with preoperative anemia (Hb <130 g/l) and without it. The incidence and the nature of internal organ damage were compared in patients with postoperative Hb < 90 g/l and 90–130 g/l.

Results The presence of postoperative anemia detected in 45 % of patients at two days after the surgery 6-fold increased the risk of acute heart failure (odds ratio [OR], 5.75; 95 % confidence interval [CI], 1.23–26.84; р=0.016), 4-fold increased the risk of multiorgan failure (MOF) (OR, 4.2; 95 % CI, 1.16–15.64; р=0.03), and 5-fold increased the likelihood of hemotransfusion (OR, 4.74; 95 % CI, 3.12–7.19; р<0.0001). Severe and moderate anemia (Hb <90 g/l) was observed in 11.2 % of patients, which presence 6-fold increased the risk of brain dysfunction (OR, 5.72; 95 % CI, 2.17–15.06; р=0.001) and MOF (OR, 5.97; 95 % CI, 1.94–18.35; р=0.004) compared to patients with Hb 90–130 g/l.

Conclusion      In patients with AHD, postoperative anemia increases the risk of circulatory decompensation at two days after the surgery and of MOF and also increases the likelihood of intraoperative hemotransfusion; postoperative anemia with Hb <90 g/l increases the risk of brain damage and MOF.

 

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