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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