VOLEMIC AND HEMODYNAMIC STATUS OF PATIENTS WITH COMORBIDITY OF CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE BEFORE AND AFTER MYOCARDIAL REVASCULARIZATION
https://doi.org/10.36604/1998-5029-2019-74-8-15
Abstract
Introduction. The comorbidity of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) significantly worsens the clinical course of these pathologies, which determines the need for careful hemodynamic monitoring during coronary artery bypass grafting (CABG). Aim. To evaluate the parameters of central and pulmonary hemodynamics during the performance of CABG under conditions of cardiopulmonary bypass (CPB) in patients with comorbidity of IHD and COPD. Materials and methods. Two groups of patients with IHD before and after CABG were examined. The first group included 11 patients with coronary heart disease in combination with COPD II-III severity without exacerbation, the second group included 29 patients with coronary heart disease without pulmonary pathology. Volumetric and hemodynamic parameters were measured by transpulmonary thermodilution using a Dräger Delta XL monitor and the Pulsion PiCCO Plus module (Germany) at three stages of the study: after the start of artificial lung ventilation; completion of the CPB procedure; 24 hours after IR. Results. For patients with comorbidity of coronary heart disease and COPD, a specific set of volumic and hemodynamic parameters was characteristic that distinguishes them from persons with coronary artery disease without pulmonary pathology. In the early postoperative period, this was manifested by the formation of a hypokinetic type of blood circulation, an increase in systemic vascular resistance, a less noticeable decrease in the global final diastolic volume, intrathoracic and pulmonary blood volumes. In addition, in patients with cardio-respiratory comorbidity, the maximum values of the indices of extravascular water in the lungs and permeability of the pulmonary vessels were recorded. Timely diagnosis of these disorders contributed to the restoration of pulmonary hemodynamics and water balance. Conclusion. When conducting CABG in patients with comorbidity of IHD and COPD, it is advisable to use the method of transpulmonary thermodilution, which provides more accurate control of hemodynamics and a personalized approach to correcting its disorders.
About the Authors
B. I. Geltzer
Far Eastern Federal University, School of Biomedicine, 10 Ajax Bay, FEFU Campus
Russian Federation
Russian Federation
MD, PhD, D.Sc. (Med.), Professor, Corresponding member of RAS, Director of the Department of Clinical Medicine
Building 25, Primorsky Krai, 690920, Russian Federation
E. A. Sergeyev
Far Eastern Federal University, School of Biomedicine, 10 Ajax Bay, FEFU Campus
Russian Federation
MD, Anesthesiologist-resuscitator of the FEFU Medical Center, Postgraduate student
Building 25, Primorsky Krai, 690920, Russian Federation
Russian Federation
MD, Anesthesiologist-resuscitator of the FEFU Medical Center, Postgraduate student
Building 25, Primorsky Krai, 690920, Russian Federation
V. Yu. Rublev
Far Eastern Federal University, School of Biomedicine, 10 Ajax Bay, FEFU Campus
Russian Federation
MD, Cardiovascular surgeon, Postgraduate student
Building 25, Primorsky Krai, 690920, Russian Federation
Russian Federation
MD, Cardiovascular surgeon, Postgraduate student
Building 25, Primorsky Krai, 690920, Russian Federation
E. V. Sergeeva
Pacific State Medical University
Russian Federation
MD, Assistant of the Institute of Pediatrics
2 Ostryakova Ave., Vladivostok, 690002, Russian Federation
Russian Federation
MD, Assistant of the Institute of Pediatrics
2 Ostryakova Ave., Vladivostok, 690002, Russian Federation
V. Yu. Velichkin
Far Eastern Federal University, School of Biomedicine, 10 Ajax Bay, FEFU Campus
Russian Federation
MD, Anesthesiologist-resuscitator
Building 25, Primorsky Krai, 690920, Russian Federation
Russian Federation
MD, Anesthesiologist-resuscitator
Building 25, Primorsky Krai, 690920, Russian Federation
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For citations:
Geltzer B.I., Sergeyev E.A., Rublev V.Yu., Sergeeva E.V., Velichkin V.Yu. VOLEMIC AND HEMODYNAMIC STATUS OF PATIENTS WITH COMORBIDITY OF CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE BEFORE AND AFTER MYOCARDIAL REVASCULARIZATION. Bulletin Physiology and Pathology of Respiration. 2019;(74):8-15. (In Russ.) https://doi.org/10.36604/1998-5029-2019-74-8-15
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