КОММЕНТАРИИ К ЕВРОПЕЙСКИМ РЕКОМЕНДАЦИЯМ ПО ВЕДЕНИЮ ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST 2017 ГОДА
В 2017 году были опубликованы обновленные Европейским рекомендациям по ведению пациентов с острым инфарктом миокарда с подъемом сегмента ST. В статье были проанализированы все новые и измененные рекомендации в плане возможности их применения в нашей стране.
Цель исследования: выявление в европейских рекомендациях 2017 года обновленных положении, основанных на обширной доказательной базе и применимых в условиях здравоохранения Республики Казахстан (РК).
Материалы и методы: первым этапом работы было проведение сравнительного анализа европейских рекомендации 2017 года с ее старой версией 2012 года. С целью выявления возможности применения данных рекомендации в Казахстане был выполнен поиск азиатских и казахстанских исследовании в онлайн-ресурсах PubMed, Cochrane Library, Trip, ScienceDirect. Поисковые запросы формировались с использованием ключевых слов: острый коронарный синдром, инфаркт миокарда, рекомендации, коронарография, стентирование.
Результаты и выводы: рекомендации ЕОК 2017 года отличаются внедрением существенных нововведений, которые можно сгруппировать в следующие пункты:
1. сочетание ПБПНПГ с клиническими симптомами ишемии миокарда являются показаниями для проведения экстренной КАГ;
2. пересмотрены временные индикаторы качества оказания помощи пациентам с ИМПST, что будет важным в условиях РК;
3. повысился класс рекомендации по предпочтительному использованию лучевого доступа от IIa к IА, что также подтверждается многочисленными исследованиями в Азии;
4. рутинная аспирационная тромбэктомия строго не рекомендуется, и эта рекомендация обоснована в странах Азии;
5.подчеркнута важность предпочтительного использования СЛП нового поколения по сравнению с ГМС, и эта рекомендация применима в Азии, хотя с меньшим уровнем доказательности;
6. рутинное использование отсроченного стентирования строго не рекомендуется, что является обоснованным в условиях Азии;
7. рутинное ЧКВ ИСА строго не рекомендуется у стабильных пациентов через 48 часов и более после начала симптомов;
8. рутинная реваскуляризация не связанных с инфарктом артерии может быть рассмотрена перед выпиской из стационара, и эта рекомендация применима в Азии, хотя с меньшим уровнем доказательности;
9. оксигенотерапия показана лишь при гипоксемии StO2 <90% (IС) и рутинная оксигенотерапия строго не рекомендована (III);
10. подчеркнута важность активной липидоснижающей терапии в зависимости от уровня липопротеинов низкой плотности, что доказало свою обоснованность в реальных клинических условиях стран Азии;
11. Подчеркнута безопасность ранней выписки пациентов из стационара, однако возможность применения данной тактики в РК требует дополнительных исследовании.
Таким образом, в РК назрела явная необходимость проведения высококачественных исследовании для выработки собственных достоверных клинических протоколов.
Ахметжан М. Галимжанов, http://orcid.org/0000-0002-1605-9512
Государственный медицинский университет города Семей, Кафедра интернатуры по терапии, г. Семей, Республика Казахстан
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Библиографическая ссылка
Галимжанов А.М. Комментарии к Европейским рекомендациям по ведению пациентов с острым инфарктом миокарда с подъемом сегмента ST 2017 года / / Наука и Здравоохранение. 2017. №5. С. 99-112