Внутриаортальная баллонная контрпульсация: современная доказательная база и нерешенные вопросы

Автор: Неверова Юлия Николаевна, Головина Т.С., Тарасов Р.С.

Журнал: Патология кровообращения и кардиохирургия @journal-meshalkin

Статья в выпуске: 3S т.24, 2020 года.

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В настоящем обзоре литературы приводится современная доказательная база о значении внутриаортальной баллонной контрпульсации в лечении пациентов в различных клинических ситуациях, включающих пациентов с острым коронарным синдромом, осложненным или не осложненным кардиогенным шоком, в сопровождении чрескожных коронарных вмешательств высокого риска, сопровождения больных, нуждающихся в аортокоронарном шунтировании, при различных состояниях, в качестве моста к принятию решения или лечению. С момента внедрения в клиническую практику внутриаортальная баллонная контрпульсация является самым распространенным методом гемодинамической поддержки у пациентов высокого риска. Классическая стратегия лечения острого инфаркта миокарда эволюционировала за последнее десятилетие от сценария тромболизиса к сценарию первичной коронарной реваскуляризации, что повлекло за собой утяжеление когорты пациенты. Однако большинство специалистов не подтверждают рутинного использования внутриаортальной баллонной контрпульсации. Исследования показали, что применение внутриаортальной баллонной контрпульсации не привело к снижению 30-дневной смертности у пациентов с острым коронарным синдромом и кардиогенным шоком, получавших терапию со стратегией ранней реваскуляризации миокарда в качестве планируемой первичной цели. Целесообразность использования в качестве метода сопровождения чрескожного коронарного вмешательства высокого риска неоднозначна, при этом использование метода в качестве моста к хирургической реваскуляризации миокарда может быть оправданным и требует выполнения дальнейших исследований в данном направлении. В статье приводятся соответствующие разделы актуальных рекомендаций по лечению пациентов, результаты исследований, обсуждаются нерешенные вопросы.

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Внутриаортальная баллонная контрпульсация, кардиогенный шок, коронарное шунтирование, острый коронарный синдром без подъема сегмента st, чрескожное коронарное вмешательство

Короткий адрес: https://sciup.org/142230753

IDR: 142230753 | DOI: 10.21688/1681-3472-2020-3S-18-32

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