Прогностическая роль чувствительности барорефлекса в оценке периоперационного риска
№ 2 (2020) , ФУНДАМЕНТАЛЬНЫЕ ВОПРОСЫ АНЕСТЕЗИОЛОГИИ И ИНТЕНСИВНОЙ ТЕРАПИИ
№ 2 (2020)
ФУНДАМЕНТАЛЬНЫЕ ВОПРОСЫ АНЕСТЕЗИОЛОГИИ И ИНТЕНСИВНОЙ ТЕРАПИИ

Прогностическая роль чувствительности барорефлекса в оценке периоперационного риска

https://doi.org/10.21320/1818-474X-2020-2-49-62
Опубликован 02.06.2020
Игорь Борисович Заболотских
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия
https://orcid.org/0000-0002-3623-2546
Н.В. Трембач
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия
https://orcid.org/0000-0002-0061-0496
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Ключевые слова

чувствительность барорефлекса
гемодинамика
анестезия
периоперационный период
послеоперационные осложнения
периоперационный риск

Как цитировать

Заболотских И.Б., Трембач Н.В. Прогностическая роль чувствительности барорефлекса в оценке периоперационного риска. Вестник интенсивной терапии имени А.И. Салтанова. 2020;(2):49–62. doi:10.21320/1818-474X-2020-2-49-62.
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Аннотация

Нарушение чувствительности барорефлекса часто сопровождает течение хронических заболеваний. Учитывая тот факт, что барорефлекторная дисфункция давно известна как долгосрочный прогностический маркер неблагоприятного исхода сердечно-сосудистых заболеваний, за последние десятилетия значительно возрос интерес к оценке роли чувствительности барорефлекса в определении периоперационного риска. Анализ литературы показал, что по запросу «барорефлекс» + «анестезия» автоматический поиск в базе PubMed позволяет выделить 592 работы, из которых пока только 28 являются рандомизированными контролируемыми исследованиями. Накоплен значительный объем экспериментальных и клинических данных, свидетельствующих о немаловажной роли барорефлекса в течение периоперационного периода. Проведенные исследования позволяют с уверенностью констатировать тот факт, что чувствительность барорефлекса, равная 3 мс/мм рт. ст., независимо от метода ее определения является критической величиной, ниже которой увеличивается вероятность неблагоприятного исхода, включая развитие периоперационных осложнений. К патофизиологическим механизмам, лежащим в основе увеличения риска при снижении чувствительности барорефлекса, относятся увеличение частоты гемодинамических критических инцидентов, большая подверженность негативным эффектам искусственной вентиляции легких, увеличение потребности в инфузионно-трансфузионной терапии, более выраженный болевой синдром и нарушение работы иммунной системы. Отрицательное воздействие общих анестетиков и нейроаксиальных методов анестезии на чувствительность барорефлекса приводит к дальнейшему увеличению риска. Учитывая роль барорефлекса в патогенезе периоперационных нарушений, его оценка может быть ключевым моментом индивидуального подхода к ведению периоперационного периода.
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