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2in the remaining patients the surgical access was open. The average duration of the operation was 4 hrs +29.58 minutes. The average time of extracorporeal circulation was 77.58 ± 35.18 minutes, the average time of aortic compression was 50.11 ± 27.29 minutes.
The data results will be presented in the form of the formula M+ct, where M is the average value, ct is the standard deviation -for normal distribution data. Data where distribution is not normal is presented as Me[25 %; 75 %], where Me is the median, and 25-75 % is the interquartile range [25 % is the 1 st, lower quartile; 75 % is the 3rd, upper quartile]. Postoperative complications are shown as n - %, where n is the number of patients, % - percentage ratio to the total number.
Results. As a result of simultaneous surgical interventions, no cases of intraoperative mortality were recorded, and complications during operations were also not observed. The average intraoperative blood loss was 321.05 +107.13 ml. The average stay in the intensive care unit was 3.84 ± 1.31 days (min = 1; max = 8). Early postoperative complications were observed in 7 patients (36.84 %): postoperative bleeding - 1 (5.26 %) on the first day, pneumonia in 4 (21.05 %) on the second day, postoperative infection in the form of suppuration of a postoperative wound - 1 (5.26 %) on the second day, pancreatic fistula -1 (5.26 %) on the second day. The average duration of hospital stay was 15 ± 2 days. For comparison, the average total duration of hospital stay for cardiac and thoracic patients with single-stage surgical interventions is 25 +2.5 days (12 ± 2 days and 13 ± 2 days, respectively). Histology examination of the dissected tissues revealed malignant neoplasms in 6 out of 19 patients: moderately differentiated adenocarcinoma of the left lung G2 with suppuration and decay of tumor tissue (1), moderately differentiated squamous cell carcinoma of lung (1), moderately differentiated gastric adenocarcinoma (2), renal cell carcinoma (2). In the remaining patients, benign neoplasms were confirmed histologically.
Conclusion. Simultaneous surgical interventions are safe, decrease the risk of repeated surgeries and anesthesia, reduce duration of intensive care and hospital stay by an average of 40 %, promote rehabilitation of patients in the postoperative period. There are also economic advantages in the form of cost reduction and spared diagnostic tests. Despite high technical requirements for such interventions, their complexity and duration, simultaneous operations undoubtedly remain a vital requirement of modern surgery.
FEATURES OF THE CLINICAL COURSE OF CORONARY HEART DISEASE IN PATIENTS
OF DIFFERENT AGE GROUPS
Khadzhilaeva F.D., Batchaeva A.M., Khadzhilaev I.D., Kodzhakova T.S.
Stavropol State Medical University, Stavropol, Russia
Annotation. Sociological profile of patients with ischemic heart disease, patients present mainly in the age groups: in group 1 - at the age of 42 years, in the second group 57, in the 3rd group, 68 years. An increase in the frequency of coronary artery bypass grafting, coronary stenting, stable angina pectoris III FC, myocardial infarction and arterial hypertension is associated with an increase in age, which is accompanied by an increase in the frequency of this disease and corresponds to the data of scientific literature sources [10, 11]. An increase in the number of female patients suffering from coronary heart disease in the elderly and senile ages indicates the occurrence of menopause, which means a decrease in the cardioprotective effect of female sex hormones, and therefore in the elderly and senile ages there are more female patients suffering from coronary heart disease, which corresponds to and is confirmed by literary sources [8], [10], [12], this trend is also possible due to high mortality in men [9]. An increase in the frequency of complaints: shortness of breath, pain behind the sternum, heartbeat is associated with an increase in age, which is accompanied by an increase in the frequency of this disease [10, 11]. With increasing age in patients with coronary heart disease, the concentrations of total cholesterol (TC), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL) in the blood serum increase: TC (total cholesterol): Group 1 - 5.3 mmol / l; group 2-5.6 mmol/l; group 3 -5.7 mmol/l. LDL (low-density lipoproteins): Group 1 - 3.5 mmol/l; group 2 - 3.4 mmol/l; group 3 - 3.6 mmol/l. VLDL (very low-density lipoproteins): Group 1 - 1.66 mmol/l; Group 2 - 1.74 mmol/l; Group 3 - 1.9 mmol/l, which corresponds to and is confirmed by literature sources [2, 5, 11-14]. The content of TG (triglycerides) in patients with coronary heart disease does not undergo significant changes:TG (triglycerides): Group 1 - 2.6 mmol/l; group 2 - 2.8 mmol/l; group 3 - 3.0 mmol/l, which corresponds to and is confirmed by sources [2, 5, 11-14]. HDL levels in patients with coronary heart disease tend to decrease with increasing age: HDL (high-density lipoproteins): Group 1 - 1.1 mmol/l; group 2 - 0.9 mmol/l, group 3 - 0.8 mmol/l, which also corresponds to and is confirmed by the literature [4, 6, 7, 12].
Introduction. heart disease (CHD) is a pathological condition manifested by an absolute or relative violation of the blood supply to the myocardium as a result of damage to the coronary arteries of the heart (WHO, 1965) [1-6]. Diseases of the cardiovascular system caused by atherosclerosis and their complications are the main cause of disability and mortality among adults in developed countries of the world, including in the Russian Federation [1, 7]. The incidence of coronary heart disease increases with age due to hereditarily determined aging processes and the development of atherosclerosis, therefore, coronary heart disease is considered an age-associated disease [2, 3]. The clinical course of coronary heart disease in the age aspect has features due to the degree of stenosis of the coronary arteries of the heart, cardiovascular risk factors and concomitant pathology [5, 9]. Of particular interest is the study of coronary heart disease at a young age [6, 8]. Patients who were first diagnosed with coronary heart disease at a young age differ from elderly patients in the course of the disease, clinical manifestations, the presence of risk factors, and outcomes of the disease [4]. In 90 % of cases, patients with coronary heart disease at a young age already have at least one risk
Кардиология и ангиология, сердечно-сосудистая хирургия
factor for the development of cardiovascular diseases (CVD) [5]. The presence of these factors at a young age can lead to the development of myocardial infarction [10, 12, 14]. The role of risk factors for cardiovascular diseases in the category of patients over 65 years of age, who make up a large proportion of patients with coronary heart disease, remains poorly studied [13]. A number of studies say that passport age cannot always be used as an estimated factor of cardiovascular risk in the elderly [8], because aging of the body itself does not always become a factor provoking the development of pathogenetic processes leading to the emergence of diseases [9]. With age, the incidence of concomitant diseases that mask the clinical picture of coronary heart disease increases, which causes the need for timely diagnosis of coronary heart disease and the appointment of the most appropriate therapy [10]. Diagnosis of coronary heart disease is often difficult due to the fact that elderly patients are not always able to perform the required load during exercise tests due to the presence of a number of diseases, such as chronic obstructive pulmonary disease, peripheral artery disease [11]. These circumstances determined the relevance and were the basis for this study.
Goal. To identify the features of the clinical course of coronary heart disease in patients of different age groups.
Tasks. To identify the frequency of coronary heart disease in the age aspect. To analyze the clinical features and risk factors for the development of coronary heart disease in groups of young, middle and elderly (senile) ages.
Scientific novelty. The true prevalence of coronary heart disease in combination with GB and leading risk factors among patients of different age groups was established, and the revealed biochemical disorders in patients with coronary heart disease of different age groups were assessed.
Method, material. We conducted a retrospective analysis of the medical histories of patients with coronary heart disease, for the period of 2019, in the Department of Cardiology, on the basis of the Cherkessk RGBUZ "Cherkessk City Clinical Hospital". 260 case histories were analyzed, patients were divided into 3 groups (Table. 1), according to the 2018 WHO age classification: group 1 - young people (25-44 years old); group 2 - middle-aged people (45-59 years old); group 3 elderly and senile (60-90 years old).
The results of the study. Males were less common in group 3 65 (47.1 %) - elderly and senile patients, which indicates a decrease in the cardioprotective effect of female sex hormones, and therefore, in elderly and senile age, there are more female patients suffering from coronary heart disease, which corresponds to and is confirmed by a scientific literary source [12]. The average age of group 1 patients was 42 years, group 2 patients - 57 years, group 3 patients - 68 years. Patients of group 3 most often had a history of coronary artery bypass grafting, coronary stenting - 28 (20.29 %). The frequency of stable angina pectoris II FC had no significant differences in the 1st and 3rd study groups - 16 (51.61 %) and 69 (50 %), respectively. Stable angina pectoris III FC prevailed in group number 3 - 64 (46.38 %). The incidence of myocardial infarction had no significant differences in the study groups, varied within 15.94 %. Hypertension was statistically significantly more common in senile and elderly patients, relatively young patients (98.55 % vs. 83.87 %), and the frequency of its detection did not differ at all in patients of groups 1 and 2, as well as 2 and 3 (group 1 - 83.87 %, group 2 - 92.3 %; group 3 - 98.55 %). Thus, an increase in the frequency of coronary artery bypass grafting, coronary stenting, stable angina pectoris III FC, myocardial infarction and hypertension is associated with an increase in age, which is accompanied by an increase in the frequency of this disease, which corresponds to and is confirmed by the data of scientific literature sources [10], [11]. Young and middle-aged patients smoke much more often - 22 (70.96 %) and 48 (52.75 %) accordingly, 38 (27.54 %) patients were older and senile. Patients of the third group were less likely to have a burdened heredity in the form of an early onset of coronary heart disease - 34 (24.64 %). In elderly patients, abdominal obesity was less common 15 (10.87 %) than in young people 19 (61.29 %). Males were less common in group 3, 65 (47.1 %) - elderly and senile patients. An increase in the number of female patients suffering from coronary heart disease in the elderly and senile age indicates the occurrence of menopause, which means a decrease in the cardioprotective effect of female sex hormones, and therefore in the elderly and at different ages, there are more women suffering from coronary heart disease, which corresponds to and is scientifically confirmed by literary sources [8],[10],[12], and also a similar trend is possible due to high mortality in men [9]. Patients of group 2 (middle-aged persons), more often than other groups, complained of shortness of breath and pain behind the sternum - 82 (90.11 %) and 77 (84.62 %), respectively. There is a significant difference between patients of the young age group and patients of the middle and elderly age groups in the presence of palpitations: group 1 -3 (9.68 %); Group 2 - 41 (45.05 %) and group 3 - 56 (40.58 %), respectively. Thus, an increase in the frequency of complaints, such as shortness of breath, chest pain, palpitations, is associated with an increase in age, which is accompanied by an increase in the frequency of this disease, which corresponds to and is confirmed by scientific literature sources [10, 11]. The analysis of total cholesterol in the blood showed the presence of its elevated content (hypercholesterolemia) in all three groups studied: group 1 -5.3 mmol/l; group 2 - 5.6 mmol/l; Group 3 - 5.7 mmol / l, respectively, as evidenced and scientifically confirmed by the fact that an increase in cholesterol in the blood (hypercholesterolemia) increases the risk of thickening and compaction of the artery wall with subsequent disturbances of local circulation and is one of the components of biochemical components of coronary heart disease [1, 4, 7]. Atherosclerotic vascular lesion, according to statistics, increases the likelihood of myocardial infarction, stroke [1, 4, 7]. Analysis of the blood lipid spectrum showed the presence of dyslipidemia in patients of all study groups; more significant changes in the content of atherogenic lipoproteins were noted in patients with CHD of the older age category -3 groups: VLDL (1.9 mmol/L), LDL (3.6 mmol/L), increased LDL and VLDL indicate a tendency to develop atherosclerosis of blood plasma, and is a component of the biochemical criterion of CHD [1, 4, 7]. In all the studied groups, an increase in the level of triglycerides in the blood was observed: group 1 - 2.6 mmol/l; group 2 - 2.8 mmol/l; Group 3 - 3.0 mmol/l, indicates and is confirmed by the scientific literature that an increased level of triglycerides in the blood is associated with the development of atherosclerosis, coronary heart disease, cerebrovascular disease [2],[3],[8]. In all the studied groups, there was a decrease in the level of high-density lipoproteins: group 1 - 1.1 mmol/L., group 2 - 0.9 mmol/L., group 3 - 0.8 mmol/L., which also indicates and
is confirmed by scientific literature that reduced HDL indicates the possibility of atherosclerosis, coronary heart disease, cerebro-vascular disease [2, 3, 8]. Thus, we found that with increasing age in patients with coronary heart disease, the concentration of total cholesterol (OHC), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL) the blood serum increases: 1) OHS (total cholesterol): Group 1 - 5.3 mmol/l; group 2 - 5.6 mmol/l; group 3 - 5.7 mmol/l. 2) LDL (low-density lipoproteins): Group 1 - 3.5 mmol/l; group 2 - 3.4 mmol/l; group 3 - 3.6 mmol/l. 3) VLDL (very low density lipoproteins): Group 1 -1.66 mmol/l; group 2 - 1.74 mmol/l; Group 3 - 1.9 mmol/ l, which corresponds to and is confirmed by literary sources [2, 5, 11-14]. We found that the content of TG (triglycerides) in patients with coronary heart disease does not undergo significant changes: TG (triglycerides): Group 1 - 2.6 mmol/l; group 2 - 2.8mmol/l; group 3 - 3.0 mmol/l, which corresponds to and is confirmed by literary sources [2, 5, 11-14]. It was found that the level of HDL (high-density lipoproteins) in patients with coronary heart disease tends to decrease with increasing age: HDL (high-density lipoproteins): Group 1 - 1.1 mmol/l; group 2 - 0.9 mmol/l, group 3 - 0.8 mmol/L, which also corresponds to and is confirmed by the literature [4, 6, 7, 12].
Conclusions. The sociological portrait of patients with coronary heart disease is presented mainly by patients of different ages: in group 1 - at the age of 42 years, in the second group - 57 years, in group 3 - 68 years. 1) An increase in the frequency of coronary artery bypass grafting, coronary stenting, stable angina pectoris III FC, myocardial infarction and hypertension is associated with an increase in age, which is accompanied by an increase in the frequency of this disease and corresponds to the data of scientific literature [10, 11]. 2) An increase in the number of female patients suffering from coronary heart disease in the elderly and senile age indicates the occurrence of menopause, which means a decrease in the cardioprotective effect of female sex hormones, and therefore in the elderly and senile age there are more women suffering from coronary heart disease, which corresponds to and is confirmed by the literature sources [8],[10],[12], and also a similar trend is possible due to high mortality in men [9]. 3) An increase in the frequency of complaints: shortness of breath, chest pain, palpitations is associated with an increase in age, which is accompanied by an increase in the frequency of this disease [10, 11]. 4) With increasing age in patients with coronary heart disease, the concentration of total cholesterol (OHC), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL) the blood serum increases: OHS (total cholesterol): Group 1 - 5.3 mmol/l; group 2 - 5.6 mmol/l; group 3 - 5.7 mmol/L. LDL (low density lipoproteins): Group 1 - 3.5 mmol/l; Group 2 - 3.4 mmol/L; group 3 - 3.6 mmol/L. VLDL (very low density lipoproteins): Group 1 - 1.66 mmol/l; group 2 - 1.74 mmol/l; group 3 - 1.9 mmol/l, which corresponds to and is confirmed by literary sources [2, 5, 11-14]. 5)The content of TG (triglycerides) in patients with coronary heart disease does not undergo significant changes: TG (triglycerides): Group 1 - 2.6 mmol/l; group 2 - 2.8mmol/l; group 3 - 3.0 mmol/L, which corresponds to and is confirmed by sources [2, 5, 11-14]. 6) HDL levels in patients with coronary heart disease tend to decrease with increasing age: HDL (high density lipoproteins): Group 1 - 1.1 mmol/l; group 2 - 0.9 mmol/l, group 3 - 0.8 mmol/L, which also corresponds to and is confirmed by the literature [4, 6, 7, 12].
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