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2Кардиология и ангиология, сердечно-сосудистая хирургия
Заключение. Сочетание низкой ТФН и ГУК у мужчин молодого возраста - неблагоприятное сочетание, ассоциируемое с рядом других ФР, которые в будущем могут реализоваться МС, АГ и ССЗ. В этом аспекте важно еще раз подчеркнуть опасность симультанного участия ФР в кардиоваскулярном и общем отдаленном прогнозе. Оценка урикемии считается обязательной на инициальном этапе обследования пациента с АГ или с развившимся ССЗ. Полученные нами данные подтверждают существующие представления о влиянии нарушений метаболизма МК на динамику состояния органов-мишеней в условиях, например, существующей АГ, а также на взаимосвязь нарушений пуринового обмена с нарушениями липидного и углеводного метаболизма, ожирением, наполняя известные критерии МС.
Выводы. При оценке физической работоспособности и гемодинамического ответа по данным велоэргометрического тестирования установлено, что мощность и общий объем выполненной нагрузки, а также доля лиц, достигших субмаксимальной частоты сердечных сокращений, толерантность к физической нагрузке, максимальная частота сердечных сокращений и доля лиц с нормотензивной реакцией артериального давления на нагрузку у лиц с высокой толерантностью к физической нагрузке и нормоурикемией достоверно превышали аналогичные параметры у лиц со средней и низкой толерантностью к физической нагрузке и гиперурикемией.
Напротив, исходная частота сердечных сокращений, исходные систолическое и диастолическое артериальное давление, диастолическое артериальное давление на высоте нагрузки и в восстановительном периоде, а также доля лиц с гипертензивной реакцией АД на нагрузку у лиц с высокой толерантностью к физической нагрузке и нормоурикемией были достоверно меньше аналогичных параметров у лиц со средней и низкой толерантностью к физической нагрузке и гиперурикемией.
Определение толерантности к физической нагрузке при велоэргометрии является одним из показаний для проведения нагрузочных проб, и, помимо определения степени физической тренированности и функционального резерва помогает более точно определить состояние сердечно-сосудистой системы и сердечно-сосудистый риск у мужчин молодого и среднего возраста при скрининговых обследованиях и экспертизах, у лиц без сердечно-сосудистых заболеваний и клинически значимой соматической патологии, но имеющих факторы риска сердечно-сосудистых заболеваний.
SIMULTANEOUS SURGERY IN PATIENTS WITH CARDIOVASCULAR DISEASES AND NEOPLASMS OF THE ABDOMINAL AND THORACIC CAVITIES
Nurmakhan N.S.
Astana Medical University, Astana, Kazakhstan Research supervisors: Tuganbekov T.U., Dr. Sci. (Med.), Professor, Omarbekov A.ZH., AbdikarimovA.M., Saipieva D.T.
Introduction. Cardiovascular diseases and cancer are two most common pathologies in the modern world. Mortality from Ischemic heart disease in Kazakhstan is 58.2 per 100,000, and cancer is ranked third in terms of mortality after CVD and trauma. About 17,000 people die from cancer every year in Kazakhstan, of which 42 % are people of the most active age (Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan). A number of patients have a combination of these pathologies, which requires surgical treatment. Simultaneous operations make it possible to perform radical treatment of one or several pathologies at an early date, prevent the progression of the tumor, reduce or eliminate the risk of repeated intervention and anesthesia, as well as reduce the hospital stay duration and financial costs.
Objective. To describe the clinical efficacy of simultaneous surgeries in patients with abdominal and thoracic cavity neoplasms associated with heart disease.
Materials and methods. The research was conducted in Astana National Scientific Medical Center, Kazakhstan. A retrospective analysis of 19 patients' medical records was conducted to assess results of simultaneous surgeries for heart pathology and thoracic or abdominal cancer in 2018-2022. 5 patients had impairment of one or two heart valves, in one of themin combination with lung pathology, in two - with neoplasms of the stomach body, and in patient 4 and 5 - with anterior mediastinum and rectal neoplasm, respectively. One patient has a muscle bridge on the anterior interventricular branch with a neoplasm of the anterior mediastinum. The remaining 13 patients had coronary vascular lesions, of them 7 in combination with lung neoplasms, 2 with kidney neoplasms, 3 with gastrointestinal tract lesions and one with anterior mediastinal neoplasm. Arterial hypertension as a concomitant disease was diagnosed in 10 (52.63 %) patients, and 4 (21.05 %) patients have chronic diseases of the gastrointestinal tract.
Аortocoranary bypass surgery was performed in 13 patients, of which three had additional heart valve surgery and one had the Bentall-de Bono procedure. In all 13 patients, CABG was performed in combination with definitive surgery in the form of organ resection (laparoscopic nephroureterectomy (1), radical nephroureterectomy (1), lobectomy (7), thymectomy (1), corporocaudal pancreatic resection with splenectomy (1), subtotal distal gastric resection with lymphodissection D2 (1), laparoscopic anterior rectal resection (1)). In 5 patients, plastic surgery of the heart valves was performed, of which two additionally underwent the Bentall-de Bono procedure, in combination with the lung surgery, such as, pneumolysis, apicolysis, resection of the upper lobe of the left lung (1), gastrectomy with resection of the abdominal esophagus, lymphodissection D2 (1), subtotal distal resection stomach with lymphodissection D2 (1), thymectomy (1), laparoscopic abdominal-perineal resection of the rectum (1). Excision of the muscular bridge of the left anterior descending coronary artery in combination with thymectomy was performed in 1 patient. In 11 out of 19 simultaneous operations, the cardiac surgery preceded the general surgery. In 3 cases, the laparoscopy was performed,
Вестник медицинского института «РЕАВИЗ». 2023. Том 13. № 2. Приложение
in 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
