The state of the oxygen budget in patients with acute coronary syndrome in coronary artery bypass graft in the perioperative period
Background. Among the diseases of the circulatory system, which are the main cause of death among middle-aged people and the elderly in many developed countries of the world, ischemic heart disease is one of the most common. At the same time, the high incidence of risk factors and the absence of a unified approach to preventing their impact on the body determine the importance of finding the best ways to treat these patients. The purpose of the study: to investigate the course of the perioperative period in patients who underwent coronary artery bypass graft for acute coronary syndrome. Materials and methods. The course of anesthesia and early postoperative period was studied in 37 patients with acute coronary syndrome who underwent coronary artery bypass surgery. The studies were carried out at the following stages: 1) before the operation; 2) at the exit from perfusion; 3) transfer to the intensive care unit; 4) transfer from the intensive care unit. At these stages, the final diastolic and systolic volume, the frequency of cardiac contraction, the parameters of systemic oxygen transport in the body were recorded. Results. It was found that acute coronary syndrome is accompanied in most cases by the development of acute heart failure, which is confirmed by a decrease in the cardiac index to less than 2.5 l/min ∙ m2 in 73.0 ± 7.3 % of patients. The use of the anesthesia protocol for coronary artery bypass grafting, including the use of β1-blocker metoprolol tartrate and nitroglycerin against dobutamine infusion, allows the cardiac index to be normalized in 94.6 ± 3.7 % of patients with acute coronary syndrome. Conclusions. The protocol using β1-blocker metoprolol tartrate and nitroglycerin against the background of dobutamine infusion is highly effective in patients with acute coronary syndrome during coronary artery bypass surgery, which allows to maintain the preoperative level and to normalize the lactate level in the vast majority of patients (94.6 ± 5.4 %).
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