GEMODINAMIK VA INFUZION TERAPIYANING MITRAL QOPQOQNI PROTEZLASH NATIJALARIGA TA’SIRI: JIHATLAR VA OMIL TAHLILI
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mitral qopqoq yetishmovchiligi, mitral qopqoqni protezlash, operatsiyadan keyingi davr, exokardiyografiya, gemodinamika, infuzion terapiya, xavf omillari##article.abstract##
Tadqiqot maqsadi: sun'iy qon aylanish sharoitida mitral qopqoqni protezlash (MQP) dan keyin uzoq muddatli yurak-qon tomir tizimi yordami bilan bog‘liq omillarni o‘rganish.
Material va usullar: Tadqiqotda kardiojarrohlik operatsiyasidan o‘tgan bemorlar ishtirok etdi. Cheklash mezonlari: 18 yoshdan kichik yoki 80 yoshdan katta, ilgari jiddiy yurak yoki buyrak disfunktsiyasi, ilgari mavjud bo‘lgan anemiya, qon transfuziyasini talab qiluvchi surunkali kasalliklar, steroid preparatlari bilan uzoq muddatli davolash, surunkali jigar kasalligi, faol infektsiya yoki sepsis, shoshilinch yoki takroriy jarrohlik, ekstrakorporal detoksikatsiya usullari bilan elektiv terapiya. Tadqiqot ob'ekti 146 nafar mitral qopqoq yetishmovchiligi bo‘lgan bemorlar bo‘lib, ular «Akademik V.Vohidov nomidagi RIXIATM» da MQP operatsiyasini o’tkazishgan. Bemorlarning o‘rtacha yoshi 41,1±3,0 yoshni tashkil etdi. Erkak bemorlar ustunlik qildi: 81 (55,5%).
Natijalar: Jami 58 (39,7%) bemorda uzoq muddatli gemodinamik va farmakologik yordami rivojlangan. Bu bemorlar yoshi kattaroq edi (r<0.02), EuroSCORE II ko‘rsatkichi yuqori (r<0.0001), chap qorincha qisqarish fraktsiyasi (ChQQF) ≤ 30% ga kamayishi ehtimoli ko‘proq (r<0.0001) va operatsiyadan oldingi o‘pka gipertenziyasi (r<0.0001). Operatsiyadan oldin amiodarondan foydalanish (r=0.007) ham ushbu guruhda tez-tez uchraydi. Qo‘llab-quvvatlanadigan bemorlarda sun'iy qon aylanish (SQA) dan ajratishda qiyinchiliklarga duch kelish ehtimoli ko‘proq (r<0,0001), aorta tiqilib qolish vaqti (r=0,0280), SQA vaqti (r=0,01) va behushlik davomiyligi (r=0,01). Jarrohlik paytida ular norepinefrin (r<0,0001) va epinefrin (r=0,04) ning yuqori dozalarini oldilar. Qo‘llab-quvvatlangan bemorlarda intraoperatif suyuqlik iste'moli yuqori bo‘lgan (r=0,0007). SQA dan keyin laktat darajalari yuqori (r=0,005) va gematokrit pastroq (r=0,0005). Operatsiyadan keyingi davrda mexanik ventilyatsiya (r<0,0001), reanimatsiyada qolish (r<0,0001) va kasalxonada qolish muddati (r<0,0001) qo‘llab-quvvatlangan bemorlarda uzoqroq bo‘lgan. Qo‘llab-quvvatlash va o‘tkir buyrak shikastlanishining rivojlanishi o‘rtasida sezilarli bog‘liqlik mavjud edi (r=0,049).
Xulosa: MQP dan keyin uzoq muddatli yurak-qon tomir farmakologik yordami bilan bog‘liq omillar yuqori EuroSCORE II, ChQQF ≤ 30% ning pasayishi, og‘ir operatsiyadan oldingi o‘pka gipertenziyasi, amiodaronni operatsiyadan oldin qo‘llash, SQA dan ajratish qiyinligi, aorta va SQA okklyuzion vaqtini uzaytirish, norepinefrinning yuqori dozalari. va operatsiya vaqtida epinefrin, SQAdan keyin yuqori laktat darajasi va past gematokrit va operatsiyadan keyingi dastlabki 24 soat ichida ijobiy suyuqlik balansi.
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