РАЗРАБОТКА АЛГОРИТМА ДИСПАНСЕРНОГО НАБЛЮДЕНИЯ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ АОРТОКОРОНАРНОЕ ШУНТИРОВАНИЕ
Введение. Исследования свидетельствуют о том, что почти 9,4% пациентов, перенесших аортокоронарное шунтирование (АКШ), повторно госпитализируют в течение 30 дней после операции [60].
Отсутствие амбулаторных посещений врача ПМСП в течение 30 дней после выписки было связано с пятикратным увеличением риска однолетней функциональной выживаемости (коэффициент риска 5,18, p < 0,01) [60].
Согласно рекомендациям Американской кардиологической ассоциации (АНА/АСС) пациенты, перенесшие АКШ, нуждаются в специальной вторичной профилактике после выписки из стационара (контроль антиагрегантной и гиполипидемической терапии) [25].
На текущий момент в Казахстане не предусмотрено диспансерное наблюдение за пациентами перенесшими АКШ. Пациенты, страдающие ишемической болезнью сердца (нестабильная стенокардия, стенокардия напряжения, инфаркт миокарда), не разделены на перенесших оперативное лечение (АКШ, стентирование) и пациентов, находящихся на консервативной терапии.
Цель: Анализ литературы, клинико-эпидемиологических данных и существующей системы организации амбулаторной помощи на постгоспитальном этапе пациентам перенесшим АКШ.
Стратегия поиска. Проведен обзор литературы по вопросам изучения диспансерного наблюдения пациентов, перенесших АКШ, глубиной в 10 лет. Ключевые слова поиска полнотекстовых статей открытого доступа в базе PubMed: coronary artery bypass grafting, medical examination, follow-up after CABG, recovery. The algorithm of dispensary observation. Критерии включения: Публикации уровня доказательности А, В: мета-анализы, систематические обзоры, когортные и поперечные исследования. Критерии исключения: мнение экспертов в виде сообщений, рекламные статьи.
Результаты. Было показано, что пациенты, которым не оказывается последующая первичная помощь, имеют худшие долгосрочные результаты. Многие осложнения после операции АКШ связаны с системной воспалительной реакцией, связанной с искусственным кровообращением. Практикующие врачи первичной медико-санитарной помощи играют важную роль в распознавании осложнений КШ и послеоперационном уходе.
Выводы. Таким образом, необходима разработка алгоритма диспансерного наблюдения за пациентами после АКШ.
Таймаз К. Тлеуберлин1, https://orcid.org/0000-0003-1720-2197
Наталья Е. Глушкова2, https://orcid.org/0000-0003-1400-8436
Надира Н. Айтамбаева1, https://orcid.org/0000-0001-5869-1789
Сабит М. Жусупов4, https://orcid.org/0000-0002-0551-126Х
Рустем С. Казангапов4, https://orcid.org/0000-0003-1513-7432
Саматбек Т. Абдрахманов5, https://orcid.org/0000-0002-4270-3498
1 Казахстанский медицинский университет "Высшая школа общественного здравоохранения", Кафедра общественного здоровья и социальных наук, г. Алматы, Республика Казахстан;
2 Казахский национальный университет им. аль-Фараби, Кафедра эпидемиологии, биостатистики и доказательной медицины, г. Алматы, Республика Казахстан;
3 Казахстанский медицинский университет "Высшая школа общественного здравоохранения", Кафедра общественного здоровья и социальных наук, г. Алматы, Республика Казахстан;
4 Павлодарский филиал НАО "Медицинский университет Семей", г. Семей, Республика Казахстан.
5 НАО "Медицинский университет Семей", г. Семей, Республика Казахстан.
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Тлеуберлин Т.К., Глушкова Н.Е., Айтамбаева Н.Н., Жусупов С.М., Казангапов Р.С., Абдрахманов С.Т. Разработка алгоритма диспансерного наблюдения пациентов, перенесших аортокоронарное шунтирование // Наука и Здравоохранение. 2023. 5(Т.25). С. 231-240. doi 10.34689/SH.2023.25.5.029Похожие публикации:
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