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Use of a mobile application for remote monitoring of patients with chronic heart failure in clinical practice 在临床实践中使用移动应用程序远程监测慢性心力衰竭患者
Pub Date : 2022-05-28 DOI: 10.38109/2225-1685-2022-2-86-95
A. Rustambekova, A. M. Noruzbaeva, B. Kurmanbekova
The steady growth and prevalence of chronic heart failure (CHF) leads to an increase in mortality, repeated hospitalizations and disability of the population. More than half of rehospitalizations are due to poor adherence to therapy, the impossibility of timely observation by a doctor, and inadequate patient education in the basics of self-control and self-help during and after discharge. In order to improve the quality of life of patients with CHF, reduce the frequency of readmissions and mortality, it is necessary to create programs to optimize outpatient care with the possibility of monitoring clinical indicators and timely correction of therapy, which can be done using digital technologies — mHealth. The ubiquity of mobile phones and portable gadgets is thought to make the introduction of remote monitoring software more affordable and cost effective. Thus, the purpose of the review is to collect and analyze the available literature data on the use of mobile technology programs for non-invasive remote monitoring of patients with CHF. Thus, studies investigating the impact of remote monitoring on the course of CHF have included widely varying patient cohorts using dissimilar devices with different support packages. Of course, the heterogeneity of both the sample and the methods used led to the inconsistency of the data obtained, the inability to compare and evaluate the results in full. Along with this, the inability to directly compare different methods of remote monitoring of patients with CHF determines the impossibility of choosing the most effective of them, which, in turn, dictates the need for standardization of methods according to, including the healthcare system in each individual country. Overall, mHealth applications offer a potentially cost-effective solution with continued access to symptom monitoring, encouraging patient engagement in self-care and self-monitoring, and improved outcomes over standard practice. While there is considerable evidence for the effectiveness of remote monitoring programs, many areas of uncertainty remain, and mobile phone interventions require further careful evaluation. Although the available data is insufficient to confirm the impact of mobile phone monitoring, it is clear that the potential is enormous.
慢性心力衰竭(CHF)的稳步增长和流行导致死亡率、反复住院和人口残疾的增加。超过一半的再住院是由于治疗依从性差,医生不可能及时观察,以及患者在出院期间和出院后对自我控制和自助基础知识的教育不足。为了提高CHF患者的生活质量,减少再入院频率和死亡率,有必要创建方案,以优化门诊护理,监测临床指标和及时纠正治疗的可能性,这可以使用数字技术-移动健康来完成。人们认为,移动电话和便携设备的普及,使远程监控软件的引入更实惠,成本更低。因此,本综述的目的是收集和分析关于使用移动技术程序对CHF患者进行无创远程监测的现有文献数据。因此,调查远程监测对CHF病程影响的研究包括了使用不同设备和不同支持包的不同患者队列。当然,由于样本和方法的异质性,导致所获得的数据不一致,无法对结果进行充分的比较和评价。除此之外,由于无法直接比较对CHF患者进行远程监测的不同方法,决定了不可能选择其中最有效的方法,这反过来又决定了需要根据每个国家的医疗保健系统对方法进行标准化。总的来说,移动健康应用程序提供了一种潜在的经济有效的解决方案,可以持续获得症状监测,鼓励患者参与自我护理和自我监测,并且比标准实践改善了结果。虽然有相当多的证据表明远程监测程序的有效性,但许多领域仍然存在不确定性,移动电话干预需要进一步仔细评估。虽然现有的数据不足以证实移动电话监测的影响,但很明显,潜力是巨大的。
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引用次数: 1
Cardiovascular diseases in patients with psoriasis in clinical practice: case report. Eurasian heart journal 心血管疾病在银屑病患者中的临床应用:1例报告。欧亚心脏杂志
Pub Date : 2022-03-09 DOI: 10.38109/2225-1685-2022-1-94-99
O. A. Kuzmina, O. Mironova, V. V. Fomin
Psoriasis is a genetically determined multifactorial disease that affects about 2% of the population. According to modern concepts of this disease, the level of comorbid diseases, especially those associated with damage to the cardiovascular system, is high. This article presents a clinical case of severe disseminated psoriasis vulgaris, progressive stage, mixed form in a patient with a very high cardiovascular risk. The uniqueness of this clinical case lies in the combined course of psoriasis and such comorbid diseases as: severe hypertension, obesity, dyslipidemia, type 2 diabetes mellitus (DM), hyperuricemia. The main clinical manifestations were the presence of widespread lesions on the patient’s skin, episodes of discomfort behind the sternum during physical activity, as well as destabilization of blood pressure numbers (maximum rise to 180/100 mm Hg). As part of the hospitalization in the skin clinic, the patient underwent topical ointment therapy with the use of glucocorticoid ointments, ointments containing salicylic acid, PUVA therapy, as a result of which the skin process showed positive dynamics with regression of lesions by 90-100% with an outcome in residual hyperpigmentation, no new lesions were noted. During hospitalization to a therapy department, the optimal antihypertensive, lipid-lowering, uricosuric, hypoglycemic therapy was selected, as a result of which it was possible to achieve an improvement in the patient’s condition, stabilization of blood pressure at the level of 130-140/70 mm Hg. So patients with psoriasis require careful assessment of cardiovascular risk in clinical practice. A multidisciplinary approach will not only improve the quality of life of patients, reduce the likelihood of major cardiovascular events, but also increase life expectancy and reduce mortality.
牛皮癣是一种由基因决定的多因素疾病,影响约2%的人口。根据这种疾病的现代概念,合并症的发病率很高,特别是那些与心血管系统损伤有关的疾病。这篇文章提出了一个临床病例严重播散寻常型银屑病,进行性阶段,混合形式的病人有非常高的心血管风险。本病例的独特之处在于牛皮癣合并了严重高血压、肥胖、血脂异常、2型糖尿病、高尿酸血症等合并症。主要临床表现为患者皮肤广泛病变,体力活动时胸骨后不适发作,以及血压数值不稳定(最大升高至180/100 mm Hg)。作为皮肤门诊住院治疗的一部分,患者接受了局部软膏治疗,使用糖皮质激素软膏、含有水杨酸的软膏、PUVA治疗,结果皮肤过程显示出积极的动态变化,病变消退了90-100%,结果是残留的色素沉着,没有发现新的病变。在治疗科住院期间,选择降压、降脂、降尿、降糖的最佳治疗方案,使患者的病情得到改善,血压稳定在130-140/70 mm Hg。因此,银屑病患者在临床实践中需要仔细评估心血管风险。多学科的方法不仅可以提高患者的生活质量,减少主要心血管事件的可能性,还可以延长预期寿命并降低死亡率。
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引用次数: 1
Frequency of arrythmia depending on the severity of the functional class in patients with metabolic syndrome and heart failure 心律失常的频率取决于代谢综合征和心力衰竭患者功能等级的严重程度
Pub Date : 2022-03-09 DOI: 10.38109/2225-1685-2022-1-90-93
D. Kurbanova, R. L. Dashdamirov
Study objective: to study the incidence of arrhythmias in patients with metabolic syndrome and heart failure in accordance with the severity of the functional class (1964, according to the NYNA classification).Materials and methods: The study included 90 patients with heart failure (HF) II and III functional class (FC), EF<50% and metabolic syndrome, who received outpatient and inpatient treatment at the J. Abdullaeva Scientific Researh Institute. Among the patients, 57 were with HF II (according to the NYNA classification), and 33 were with HF III functional class. The age of the patients ranged from 36 to 88 years. Of these, 27% were women, 63% were men. The patients underwent complex clinical, instrumental and laboratory examinations. Instrumental examinations included daily monitoring of the electrocardiogram by the Holter method (with CONTEC, TLC 5000), 6-minute walking test, blood ion analysis, MS indicators, and lipid spectrum research. Exclusion criteria were chronic obstructive pulmonary disease, bronchial asthma, cardiomyopathies,heart defects.Results: The incidence of ventricular premature beats (especially in an amount greater than 1000) among patients with heart failure of the III functional class (97.0%) is slightly higher than in patients of the II functional class (91.2%). However, supraventricular premature beats are more common (78.9%) in patients with functional class II heart failure than in functional class III patients (57.6%). Atrial fibrillation in patients with heart failure of functional class III (33.3%) occurs approximately 1.7 times more often than in patients of functional class II (19.3%). Almost the same frequency of occurrence of episodes of sinus rhythm and atrial fibrillation were observed. Shortterm ventricular tachycardia was recorded in 2 patients of functional class III.Conclusions: In patients with metabolic syndrome, the incidence of ventricular premature beats and atrial fibrillation correlate with the functional class of heart failure, and episodes of ventricular tachycardia are also observed.
研究目的:研究代谢综合征合并心力衰竭患者心律失常的发生率,按照功能分级的严重程度(1964年,根据NYNA分级)。材料与方法:本研究纳入90例在J. Abdullaeva科学研究所接受门诊和住院治疗的心力衰竭(HF) II和III功能分级(FC)、EF<50%和代谢综合征患者。其中ⅱ型心衰57例(NYNA分级),ⅲ型心衰功能级33例。患者年龄36 ~ 88岁。其中27%为女性,63%为男性。患者接受了复杂的临床、仪器和实验室检查。仪器检查包括每日动态心电图监测(使用CONTEC, TLC 5000), 6分钟步行试验,血离子分析,质谱指标和脂质谱研究。排除标准为慢性阻塞性肺病、支气管哮喘、心肌病、心脏缺陷。结果:ⅲ功能级心衰患者室性早搏(尤其是大于1000次)发生率(97.0%)略高于ⅱ功能级患者(91.2%)。然而,功能II级心衰患者的室上性早搏发生率(78.9%)高于功能III级心衰患者(57.6%)。功能III级心衰患者(33.3%)心房颤动的发生率约为功能II级心衰患者(19.3%)的1.7倍。观察到窦性心律和心房颤动的发生频率几乎相同。短期室性心动过速2例功能性ⅲ级。结论:代谢综合征患者室性早搏和房颤的发生率与心力衰竭的功能分级相关,室性心动过速的发生率也可观察到。
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引用次数: 0
Eurasian clinical guidelines for cardiovascular complications of cancer treatments: diagnosis, prevention and treatment (2022) 欧亚地区癌症治疗心血管并发症临床指南:诊断、预防和治疗(2022)
Pub Date : 2022-03-07 DOI: 10.38109/2225-1685-2022-1-6-79
I. Chazova, F. Ageev, A. Aksenova, M. V. Vicenya, M. Gilyarov, T. Martynyuk, E. Panchenko, M. Poltavskaya, V. I. Potievskaya, O. Trofimova, Yu. A. Fedotkina
Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
免责声明。《EAC指南》代表了EAC的观点,是在仔细考虑了科学和医学知识以及出版时可用的证据后编制的。如果EAC指南与相关公共卫生当局发布的任何其他官方建议或指南之间存在任何矛盾、差异和/或歧义,特别是在良好使用医疗保健或治疗策略方面,EAC概不负责。鼓励卫生专业人员在进行临床判断时,以及在确定和实施预防、诊断或治疗性医疗策略时,充分考虑《EAC指南》;然而,《EAC指南》并没有以任何方式推翻卫生专业人员的个人责任,即考虑到每个病人的健康状况,并与病人以及在适当和/或必要时与病人的照顾者协商,作出适当和准确的决定。《EAC准则》也不能免除卫生专业人员充分和仔细考虑主管公共卫生当局发布的有关官方最新建议或准则,以便根据科学接受的数据根据各自的道德和专业义务管理每个病人的病例。卫生专业人员也有责任在开处方时核实与药品和医疗器械有关的适用规则和条例。
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引用次数: 5
Pulmonary arterial hypertension: challenges and achievements 2021 肺动脉高压:挑战与成就
Pub Date : 2022-03-07 DOI: 10.38109/2225-1685-2022-1-80-89
E. A. Rezukhina, T. V. Martynyuk, Z. Valieva, V. Gramovich, I. Chazova
Symposium dedicated to pulmonary arterial hypertension took place at the 9th Russian Congress on Pulmonary hypertension on December 14, 2021. In this review key points from Chazova I.E., Martynyuk T.V., Valieva Z.S., Gramovich V.V.`s reports are presented, in which information about PAH treatment goals achievement, COVID-19 pandemic challenges impact on routine clinical practice is demonstrated. In this review current situation in pulmonary arterial hypertension treatment goals and regular risk stratification importance are observed, based on the latest clinical trials combined specific therapy including selective prostacyclin receptor agonist selexipag is demonstrated. special attention is paid to pulmonary hypertension patients’ treatment during COVID-19 pandemic, regular risk stratification necessity is mentioned including remote patient monitoring in order to perform timely escalation in PAH-specific treatment in order to achieve low-risk status and to improve the prognosis of PAH patients.
2021年12月14日,第九届俄罗斯肺动脉高压大会举行了专门讨论肺动脉高压的专题讨论会。本文主要从查佐娃、马尔丁纽克、瓦列耶娃、格拉莫维奇等人的观点进行综述报告中展示了多环芳烃治疗目标的实现、COVID-19大流行挑战对常规临床实践的影响等信息。本文综述了目前肺动脉高压的治疗目标和常规危险分层的重要性,基于最新的临床试验,论证了包括选择性前列环素受体激动剂selexipag在内的联合特异性治疗。特别关注COVID-19大流行期间肺动脉高压患者的治疗,提出定期风险分层的必要性,包括远程监测患者,以便及时升级PAH特异性治疗,达到低风险状态,改善PAH患者的预后。
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引用次数: 1
Eurasian guidelines for the prevention and treatment of cardiovascular diseases in patients with obesity (2022) 欧亚肥胖患者心血管疾病预防和治疗指南(2022)
Pub Date : 2022-01-10 DOI: 10.38109/10.38109/2225-1685-2022-3-6-56
I. Chazova, Y. Zhernakova, N. Blinova, T. Markova, N. Mazurina, I. Zhirov, T. Uskach, A. Safiullina, O. Mironova, E. Elfimova, A. Litvin, E. Zheleznova, Y. Yuricheva, O. Kislyak, A. Mkrtumyan, V. Podzolkov, V. Azizov, P. A. Zelveyan, E. A. Grigorenko, Z. Y. Rahimov, S. D. Kasymova, A. Narzullaeva, A. Sarybaev
   Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
免责声明。《EAC指南》代表了EAC的观点,是在仔细考虑了科学和医学知识以及出版时可用的证据后编制的。如果EAC指南与相关公共卫生当局发布的任何其他官方建议或指南之间存在任何矛盾、差异和/或歧义,特别是在良好使用医疗保健或治疗策略方面,EAC概不负责。鼓励卫生专业人员在进行临床判断时,以及在确定和实施预防、诊断或治疗性医疗策略时,充分考虑《EAC指南》;然而,《EAC指南》并没有以任何方式推翻卫生专业人员的个人责任,即考虑到每个病人的健康状况,并与病人以及在适当和/或必要时与病人的照顾者协商,作出适当和准确的决定。《EAC准则》也不能免除卫生专业人员充分和仔细考虑主管公共卫生当局发布的有关官方最新建议或准则,以便根据科学接受的数据根据各自的道德和专业义务管理每个病人的病例。卫生专业人员也有责任在开处方时核实与药品和医疗器械有关的适用规则和条例。
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引用次数: 0
Eurasian clinical guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) 欧亚大陆非st段抬高急性冠状动脉综合征(NSTE-ACS)临床诊疗指南
Pub Date : 2021-11-26 DOI: 10.38109/2225-1685-2021-4-6-59
O. Barbarash, A. L. Komarov, E. Panchenko, I. I. Staroverov, R. M. Shahnovich, I. Yavelov
The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
《EAC指南》代表了EAC的观点,是在仔细考虑了科学和医学知识以及出版时可用的证据后编制的。如果EAC指南与相关公共卫生当局发布的任何其他官方建议或指南之间存在任何矛盾、差异和/或歧义,特别是在良好使用医疗保健或治疗策略方面,EAC概不负责。鼓励卫生专业人员在进行临床判断时,以及在确定和实施预防、诊断或治疗性医疗策略时,充分考虑《EAC指南》;然而,《EAC指南》并没有以任何方式推翻卫生专业人员的个人责任,即考虑到每个病人的健康状况,并与病人以及在适当和/或必要时与病人的照顾者协商,作出适当和准确的决定。《EAC准则》也不能免除卫生专业人员充分和仔细考虑主管公共卫生当局发布的有关官方最新建议或准则,以便根据科学接受的数据根据各自的道德和专业义务管理每个病人的病例。卫生专业人员也有责任在开处方时核实与药品和医疗器械有关的适用规则和条例。
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引用次数: 2
Clinical case of a patient with pulmonary capillary hemangiomatosis: rapid progression or lost time? 肺毛细血管瘤病1例:进展迅速还是时间浪费?
Pub Date : 2021-11-26 DOI: 10.38109/2225-1685-2021-4-74-78
E. A. Devetyarova, T. Martynyuk, A. А. Dyuzhikov, E. Paschenko, A. V. Dyuzhikova
The article describes a clinical case of a 37-year-old patient with pulmonary capillary hemangiomatosis of functional class IV according to the WHO classification with difficulties of diagnostic search and features of PAH-specific therapy.Pulmonary arterial hypertension - group 1 in the clinical classification is represented by several forms of pathology, including very rare diseases such as pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.The difficulties of diagnostic search consist in the absence of specific symptoms, a variety of interstitial or focal changes according to spiral computed tomography, and the final diagnosis can be made only after performing a lung biopsy, which is associated with a high risk of possible complications. During the initial treatment and examination of the patient, clinical and hemodynamic parameters did not immediately allow to suspect the presence of pulmonary capillary hemangiomatosis. And only the difficulties of the patient’s management associated with the lack of the expected effect of the therapy with PAH-specific drugs served as the basis for further diagnostic search.Against the background of taking vasodilators, with the normalization of hemodynamic parameters, the progression of respiratory and right ventricular insufficiency was noted in the patient. According to the results of an additional examination, a diagnosis of pulmonary capillary hemangiomatosis was established, therapy was corrected and further tactics of management and treatment of the patient were determined. Currently, the patient is awaiting transplantation at V.I. Shumakov national medical research center and receives specific therapy with riociguate 2.5 mg TID and bosentan 125 mg BID.
本文报道了一例37岁肺毛细血管瘤病的临床病例,根据WHO分级为功能级IV,诊断查找困难,pah特异性治疗的特点。肺动脉高压-临床分类中的第1组以几种病理形式为代表,包括非常罕见的疾病,如肺静脉闭塞性疾病和肺毛细血管瘤病。诊断搜索的困难在于没有特定症状,根据螺旋计算机断层扫描显示各种间质或局灶性改变,并且只有在进行肺活检后才能做出最终诊断,这与可能出现并发症的高风险相关。在患者的初始治疗和检查期间,临床和血流动力学参数不能立即怀疑肺毛细血管瘤病的存在。只有患者管理的困难与使用pah特异性药物治疗缺乏预期效果相关,才能作为进一步诊断研究的基础。在服用血管扩张剂的背景下,随着血流动力学参数的正常化,注意到患者呼吸和右心室功能不全的进展。根据附加检查结果,诊断为肺毛细血管瘤病,纠正治疗方法,并确定进一步的管理和治疗策略。目前,患者正在V.I. Shumakov国家医学研究中心等待移植,并接受分离的2.5 mg TID和125 mg BID的特异性治疗。
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引用次数: 0
Hospital and mid-term results of simultaneous correction of coronary and carotid arteries 冠状动脉和颈动脉同时矫正术的住院和中期结果
Pub Date : 2021-11-26 DOI: 10.38109/2225-1685-2021-4-60-66
A. Marchenko, A. Vronskiy, P. A. Myalyuk, P. V. Lazarkov, Y. Sinelnikov
Study objective: to present the immediate and mid-term results of onestage surgical treatment of patients in the volume of CEE and CABG based on a differentiated approach to patient selection.Materials and methods: in FCCVS n.a. S.G. Suhanov, Perm developed an algorithm for choosing treatment tactics in patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries. According to this algorithm, for the period from 01.07.2014-01.01.2021, one-stage correction of CABG + CEE was performed in 104 patients. The primary endpoints were all-cause death, acute myocardial infarction (MI), transient ischemic attack (TIA), and stroke. Hospital and midterm results were analyzed. The average follow-up time in the study of mid-long-term results was 40.3 ± 20.4 months.Results: in the study of hospital outcomes, the mortality rate was 0%. There were recorded 3 (2.9%) cases of perioperative stroke and 1 (0.9%) case of myocardial infarction. There were no cases of TIA. The combined endpoint (death, acute MI, stroke, TIA) reached 4 (3.8%) patients. In the study of mid-term results, we were able to contact 96 patients out of 104 operated on (92.3%). The survival rate was 94.8%. 5 (5.2%) people died. There were 2 (2.1%) cases of myocardial infarction, 4 (4.1%) cases of stroke.Conclusions: simultaneous revascularization of the carotid and coronary regions of CABG + CEE is safe and allows adequate elimination of the lesion in both regions.
研究目的:根据患者选择的差异化方法,介绍CEE和CABG患者一期手术治疗的近期和中期结果。材料和方法:在FCCVS n.a. S.G. Suhanov中,Perm开发了一种算法,用于选择冠状动脉和头臂动脉合并动脉粥样硬化病变患者的治疗策略。根据该算法,2014年7月1日- 2021年1月1日,共104例患者行CABG + CEE一期矫正。主要终点为全因死亡、急性心肌梗死(MI)、短暂性脑缺血发作(TIA)和卒中。对医院和中期结果进行分析。中长期结果研究的平均随访时间为40.3±20.4个月。结果:在医院转归研究中,死亡率为0%。围手术期卒中3例(2.9%),心肌梗死1例(0.9%)。无TIA病例。合并终点(死亡、急性心肌梗死、卒中、TIA)达到4例(3.8%)。在中期结果的研究中,104例手术患者中,我们能够联系到96例(92.3%)。生存率为94.8%。死亡5人(5.2%)。心肌梗死2例(2.1%),脑卒中4例(4.1%)。结论:同时对CABG + CEE的颈动脉和冠状动脉区域进行血运重建是安全的,并且可以充分消除这两个区域的病变。
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引用次数: 0
Modern approaches in the treatment of patients with Paget-Schretter syndrome Paget-Schretter综合征的现代治疗方法
Pub Date : 2021-11-26 DOI: 10.38109/2225-1685-2021-4-68-72
I. Sonkin, L. Syromyatnikova, E. Alieva, S. A. Mehryakov
Goal. Consider the management of patients with effort thrombosis (Paget-Schretter syndrome).The article presents the modern vision of the problem of effort thrombosis. This review is aimed at describing the epidemiology, pathophysiology, diagnosis and treatment of patients with Paget-Schretter syndrome. SPS occurs spontaneously, as a rule, in young, healthy and active patients aged 20-30 years after strenuous physical activity. The ratio of men and women is 2:1, recently there has been a growing trend among women. The main complaints of patients with SPS include swelling of the affected limb, discomfort when moving the affected arm, pain and heaviness when trying to raise the arm up. When examining these patients, attention is paid to hyperemia of the skin or their cyanotic nature, pasty limbs, as well as an enhanced venous pattern on the shoulder, the so-called Arshel sign. The diagnosis is based on the data of anamnesis, physical examination, the “gold standard of diagnostics” – ultrasound examination of veins, the sensitivity and specificity of which is 70-100%. The first step in the diagnosis can be the evaluation of the D-dimer, with its negative values, the SPSH is rejected. With an obvious clinic and controversial results of serial ultrasound examinations, other imaging methods are used, such as computed contrast tomography, magnetic resonance imaging, the diagnostic value of which is especially significant in occlusive venous thrombosis.SPS differs not only from DVT of the lower extremities, but also from secondary DVT of the upper extremities, which determines the peculiarities of management of this category of patients, including surgical treatment aimed at preventing subclavian vein compression in the future. The article summarizes the experience in the management of patients with blood thrombosis.
的目标。考虑对心力血栓形成(Paget-Schretter综合征)患者的处理。本文提出了对努力血栓形成问题的现代视角。本文综述了Paget-Schretter综合征的流行病学、病理生理学、诊断和治疗。通常,20-30岁的年轻、健康和活跃的患者在剧烈体育活动后会自发发生SPS。男女比例是2:1,最近在女性中出现了增长的趋势。SPS患者的主要主诉包括患肢肿胀,移动患肢时不适,试图抬起手臂时疼痛和沉重。在检查这些患者时,应注意皮肤充血或其紫绀性质,四肢苍白,以及肩部静脉模式增强,即所谓的Arshel征象。诊断基于记忆、体格检查、“诊断的金标准”——静脉超声检查,其敏感性和特异性为70-100%。诊断的第一步可以是d -二聚体的评价,如果其值为负值,则拒绝SPSH。由于连续超声检查的临床结果明显,但存在争议,因此采用其他成像方法,如计算机对比断层扫描、磁共振成像等,其对闭塞性静脉血栓的诊断价值尤其显著。SPS不仅不同于下肢DVT,也不同于上肢继发性DVT,这决定了这类患者治疗的特殊性,包括旨在防止锁骨下静脉压迫的手术治疗。本文总结了血液血栓形成患者的处理经验。
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Eurasian heart journal
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