Том 23 № 3 (2019)
ОБЗОРЫ

Гемостаз при миниинвазивном искусственном кровообращении

В. Корнев
Федеральное государственное бюджетное учреждение Всероссийский центр экстренной и радиационной медицины имени А.М. Никифорова Министерства Российской Федерации по делам гражданской обороны, чрезвычайным ситуациям и ликвидации последствий стихийных бедствий, Санкт-Петербург
Bio
Д. Шелухин
Федеральное государственное бюджетное учреждение Всероссийский центр экстренной и радиационной медицины имени А.М. Никифорова Министерства Российской Федерации по делам гражданской обороны, чрезвычайным ситуациям и ликвидации последствий стихийных бедствий, Санкт-Петербург

Опубликован 27.11.2019

Ключевые слова

  • биосовместимое покрытие,
  • гемостаз,
  • искусственное кровообращение,
  • кардиохирургия,
  • коагуляция,
  • миниинвазивное искусственное кровообращение,
  • MiECC
  • ...Показать
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Как цитировать

Корнев, В., & Шелухин, Д. (2019). Гемостаз при миниинвазивном искусственном кровообращении. Патология кровообращения и кардиохирургия, 23(3), 84–97. https://doi.org/10.21688/1681-3472-2019-3-84-97

Аннотация

Экстракорпоральное кровообращение с использованием миниинвазивного контура стремительно растет в последние годы во всем мире. Усовершенствованы компоненты и биопокрытия миниинвазивного экстракорпорального контура (MiECC). Расширился спектр применения миниинвазивного искусственного кровообращения, однако основные показания к использованию MiECC в кардиохирургии не систематизированы. Отсутствуют представления о режиме антикоагулянтной терапии при проведении миниинвазивного искусственного кровообращения, его влиянии на кровопотерю и активацию коагуляции в периоперационном периоде. В данном обзоре освещены основные и дополнительные компоненты контура, практические аспекты использования MiECC. Сформулированы показания к использованию миниинвазивного контура. Классифицированы биосовместимые покрытия, используемые для снижения контактной активации гемостаза. По данным исследований, при проведении искусственного кровообращения с MiECC нарушен физиологический гемостатический баланс. Обнаруженные изменения плазменного гемостаза не позволяют сделать окончательный вывод о преимуществах MiECC, в отличии от клинических преимуществ. Требуются многоцентровые рандомизированные исследования с соблюдением правил преаналитического этапа изучения гемостаза и использованием глобальных тестов (тест генерации тромбина, тест тромбодинамики и другие). Изобилие исследований системы гемостаза при использовании MiECC не позволяет поставить точку в вопросе благоприятного влияния MiECC на систему гемостаза. Однако MiECC позволяет приблизиться к Fast Track кардиохирургии.

Поступила в редакцию 7 октября 2019 г. Исправлена 14 ноября 2019 г. Принята к печати 18 ноября 2019 г.

Конфликт интересов
Авторы заявляют об отсутствии конфликта интересов.

Финансирование
Исследование не имело спонсорской поддержки.

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