Применение эпидуральной анестезии в коронарной хирургии: за и против
№ 2 (2020) , АНЕСТЕЗИЯ И ИНТЕНСИВНАЯ ТЕРАПИЯ ПРИ ЗАБОЛЕВАНИЯХ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ
№ 2 (2020)
АНЕСТЕЗИЯ И ИНТЕНСИВНАЯ ТЕРАПИЯ ПРИ ЗАБОЛЕВАНИЯХ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ

Применение эпидуральной анестезии в коронарной хирургии: за и против

https://doi.org/10.21320/1818-474X-2020-2-86-95
Опубликован 02.06.2020
Дмитрий Александрович Волков
ФГБОУ ВО «Северный государственный медицинский университет» Минздрава России, Архангельск, Россия
https://orcid.org/0000-0003-1558-9391
К.В. Паромов
ГБУЗ АО «Первая городская клиническая больница им. Е.Е. Волосевич», Архангельск, Россия
https://orcid.org/0000-0002-5138-3617
А.В. Еремеев
ГБУЗ АО «Архангельская областная клиническая больница», Архангельск, Россия
https://orcid.org/0000-0002-8537-1163
М.Ю. Киров
ФГБОУ ВО «Северный государственный медицинский университет» Минздрава России, Архангельск, Россия
https://orcid.org/0000-0002-4375-3374
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Ключевые слова

кардиохирургия
высокая торакальная эпидуральная анестезия
кардиоанестезиология

Как цитировать

Волков Д.А., Паромов К.В., Еремеев А.В., Киров М.Ю. Применение эпидуральной анестезии в коронарной хирургии: за и против. Вестник интенсивной терапии имени А.И. Салтанова. 2020;(2):86–95. doi:10.21320/1818-474X-2020-2-86-95.
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Аннотация

Сердечно-сосудистая патология на протяжении многих лет сохраняет лидирующую позицию среди причин смерти в мире. Ведущей кардиальной патологией является ишемическая болезнь сердца, течение которой обусловлено преимущественно характером и степенью выраженности стенозирующего атеросклероза коронарного русла. Одним из хирургических способов восстановления проходимости артериального русла является аортокоронарное шунтирование. Периоперационный период коронарного шунтирования может сопровождаться респираторными осложнениями, развитием сердечной недостаточности, нарушений ритма и проводимости, почечной дисфункции и другими проблемами. Высокая эпидуральная анестезия и анальгезия за счет десимпатизации дерматомов, ассоциированных с иннервацией сердца, не только уменьшает периоперационный стресс и снижает выраженность болевого синдрома, вызванного стернотомией, но и обладает протекцией в отношении функции систем дыхания и кровообращения. Эти эффекты подтверждаются целым рядом исследований и систематических обзоров. Тем не менее рутинное использование нейроаксиальных блокад в кардиохирургии может быть ограничено повышением риска эпидуральных гематом и неврологических последствий. В обзоре приведены данные, посвященные физиологическому влиянию эпидуральной анестезии на сердце и клиническим аспектам ее применения в коронарной хирургии.
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