Том 25 № 4 (2021)
ОБЗОРЫ

Острое повреждение почек у детей после кардиохирургических вмешательств

С. Сергеев
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Министерства здравоохранения Российской Федерации, Новосибирск
В. Ломиворотов
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Министерства здравоохранения Российской Федерации, Новосибирск; Федеральное государственное автономное образовательное учреждение высшего образования «Новосибирский национальный исследовательский государственный университет», Новосибирск
Bio

Опубликован 28.12.2021

Ключевые слова

  • врожденный порок сердца,
  • искусственное кровообращение,
  • острое повреждение почек

Как цитировать

Сергеев, С., & Ломиворотов, В. (2021). Острое повреждение почек у детей после кардиохирургических вмешательств. Патология кровообращения и кардиохирургия, 25(4), 11–22. https://doi.org/10.21688/1681-3472-2021-4-11-22

Аннотация

Острое повреждение почек после кардиохирургических вмешательств у детей широко распространено. Применяемые в клинической практике подходы помогли уточнить эпидемиологию, факторы риска и патофизиологию этого состояния. Современные шкалы pRIFLE, AKIN и KDIGO, основанные на изменении уровня сывороточного креатинина и темпа диуреза, позволяют выявлять и ранжировать острое повреждение почек по степени тяжести. Однако стратегии диагностики вышли за рамки одного лишь креатинина и предлагают использовать маркеры повреждения почечной ткани. В настоящее время два из них: липокалин, ассоциированный с желатиназой нейтрофилов, а также тканевой ингибитор металлопротеиназы-2 и белок, связывающий инсулиноподобный фактор роста-7, — могут быть использованы для ранней диагностики.

Предикторами острого повреждения почек после кардиохирургических вмешательств являются ренальные и внепочечные факторы риска, наиболее весомые из которых — ранний детский возраст, длительность искусственного кровообращения, необходимость в искусственной вентиляции легких и инотропной поддержке до оперативного вмешательства. Поддержание должного перфузионного давления во время искусственного кровообращения, а также исключение нефротоксичных препаратов и перегрузки жидкостью снижают риск патологии. Ультрафильтрация и раннее начало заместительной почечной терапии в послеоперационном периоде значимо повышают выживаемость.

Для поиска и отбора литературных источников использовали базы данных PubMed, Scopus и Web of Science.

Цель обзора — анализ имеющихся в литературе данных по острому повреждению почек в детской кардиохирургии. Результаты демонстрируют различия в частоте выявления острого повреждения почек, связанного с кардиохирургическими вмешательствами, и эффективности методов профилактики и лечения данного осложнения. Дальнейшее всестороннее изучение вопроса, создание медицинских электронных баз данных о пациентах, минимизация влияния факторов риска, своевременное предупреждение и лечение осложнений позволят предотвратить патологию и снизить вероятность прогрессирования в более тяжелую стадию.

Поступила в редакцию 12 апреля 2021 г. Исправлена 24 июня 2021 г. Принята к печати 25 июня 2021 г.

Финансирование

Исследование не имело спонсорской поддержки.

Конфликт интересов

Авторы заявляют об отсутствии конфликта интересов.

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