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PRESERVED ALLOPLASTIC MATERIAL IN TREATMENT OF TUMORS AND ODONTOGENIC CYSTS IN CHILDREN 保存同种异体材料在治疗儿童肿瘤和牙源性囊肿中的应用
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2021-1-29-33
P. Zhelezny, S. P. Zhelezny, Yu.K. Zheleznaya, A. Zheleznaya, K. S. Shchelkunov, M. V. Nikolskaya, E. Piven
Long-term clinical observations on the treatment and rehabilitation of 117 children with tumors and tumor-like formations of the maxillofacial region are presented. To replace jaw defects, we used transplants preserved in various ways: frozen — in 48 patients, preserved in 0,5% formalin — in 7 patients, Kostma — in 7 pati¬ents, Deprotex — in 28 patients, Orgamax — in 27 patients. In the postoperative period, orthopedic and orthodontic rehabilitation of patients was carried out using removable and non-removable orthodontic appliances and dental implant systems. In the near term, no complications were revealed in 108 patients; consolidation of the graft with the bone bed occurred. 9 patients developed a purulent inflammatory process with allograft sequestration. The follow-ups of the patients showed that after transplantation, the allograft was gradually resorbed and replaced with a full-fledged organotypic regenerate within a period of 1,0 to 3 years. During the long-term up to 10 years follow-up, 92 patients (89,3 %) obtained good anatomical, functional and aesthetic results of rehabilitation, characterized by full restoration of the function of the dentition and facial aesthetics. In 11 patients (10,7 %), the results were satisfactory.
报告117例儿童颌面部肿瘤及肿瘤样肿瘤的治疗与康复的长期临床观察。为了替换颌骨缺损,我们使用了多种保存方式的移植物:冷冻(48例),0.5%福尔马林(7例),Kostma(7例),Deprotex(28例),Orgamax(27例)。术后,使用可移动和不可移动的正畸器具和种植体系统对患者进行矫形和正畸康复。108例近期无并发症发生;移植物与骨床发生了巩固。9例患者出现化脓性炎症过程,并伴有同种异体移植物隔离。对患者的随访显示,移植后同种异体移植物逐渐被吸收,并在1 ~ 3年内被成熟的器官型再生体所取代。在长达10年的长期随访中,92例(89.3%)患者获得了良好的解剖、功能和美观的康复效果,其特点是牙列功能和面部美观完全恢复。11例(10.7%)患者治疗效果满意。
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引用次数: 0
LYMPHOCYTE NUCLEUS AS POPULATION MONITORING TOOL FOR IDENTIFYING FETAL CHROMOSOME PATHOLOGY RISK GROUPS 淋巴细胞核作为识别胎儿染色体病理危险群体的群体监测工具
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2021-4-19-22
N. Yasakova, S. Mashak, O. V. Lisichenko, S. Zalavina, I.M. Samatova
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引用次数: 0
MORPHOFUNCTIONAL CHARACTERISTICS AND FEATURES OF SECONDARY DENTITION DEFORMITIES IN DIFFERENT AGE PERIODS 不同年龄段继发性牙列畸形的形态功能特征及特点
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-2-43-47
Yu.K. Zheleznaya, S. P. Zhelezny, E. Piven
Introduction. Currently, there is no consensus in the literature about the incidence of secondary deformities of the dentitions and their age characteristics. Thus, the question of the prevalence and features of secondary dentoalveolar deformities and anomalies of the dental arches in different age groups is relevant. Aim of the research. To study the prevalence, nature, features of secondary dentoalveolar deformities and anomalies of the dentition in different age groups. Materials and methods. For our study, we selected patients of different age groups who consulted the orthopedic dentistry clinic of the FSBEI HE Novosibirsk State Medical University of the Ministry of Health of Russia, as well as the 2–5 year students of the Faculty of Dentistry. Group 1 — 150 students aged 18–27 years, group 2 — 130 patients aged 30–45 years, group 3 — 140 patients aged 46–60 years. Results. In group 1, 150 second-fifth year students of the Faculty of Dentistry of the Novosibirsk State Medical University, aged 18–27 years, were examined. In 13 of them, the teeth were intact. Signs of secondary dentition deformities in patients of the first group were observed in 63 (42%) students. In group 2, 130 patients aged 30 to 45 years were examined, in 5 patients the dentitions were intact. Signs of secondary deformities of dentitions in the examined group 2 were observed in 71 (56%) patients. In group 3, 140 patients aged 46 to 60 years were examined, 18 of them had intact dentitions. In 122 of them, partial loss of teeth was observed. Signs of secondary deformities of the dentition in the examined group 3 were observed in 55 people (40%). Conclusion. The study shows that secondary dentition deformities can be observed both with preserved dentition in cases of multiple carious lesions of the occlusal surfaces of the teeth, anatomically incorrect restoration of the occlusal surfaces of the crowns of chewing teeth, or their contact surfaces after filling, and with partial loss of teeth in all age groups.
介绍。目前,关于牙列继发性畸形的发病率及其年龄特征,文献尚未达成共识。因此,继发性牙槽畸形和牙弓畸形在不同年龄组的患病率和特征的问题是相关的。研究的目的。探讨不同年龄组牙列继发性牙槽畸形及异常的患病率、性质、特点。材料和方法。在我们的研究中,我们选择了在俄罗斯卫生部新西伯利亚国立医科大学骨科牙科诊所就诊的不同年龄段的患者,以及牙科学院2-5年级的学生。组1 ~ 150例,年龄18 ~ 27岁;组2 ~ 130例,年龄30 ~ 45岁;组3 ~ 140例,年龄46 ~ 60岁。结果。在1150组,年龄在18-27岁的新西伯利亚国立医科大学牙科学院二、五年级学生接受了检查。其中13人的牙齿完好无损。第一组患者中有63名(42%)学生出现继发性牙列畸形的迹象。2130例患者年龄30 ~ 45岁,其中5例牙列完整。第二组有71例(56%)患者出现继发性牙列畸形。第三组140例患者,年龄46 ~ 60岁,其中18例牙列完整。其中122例出现部分牙齿脱落。在第三组中,55人(40%)观察到继发性牙列畸形的迹象。结论。本研究表明,在牙齿咬合面多发龋损、咀嚼牙冠咬合面或咬合面充填后解剖不正确修复、部分牙缺失的情况下,保留牙列均可观察到继发牙列畸形,在所有年龄组均可观察到继发牙列畸形。
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引用次数: 0
RETROSPECTIVE ASSESSMENT OF NON-MOTOR SYMPTOMS IN PARKINSON'S DISEASE 帕金森病非运动症状的回顾性评估
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-2-17-21
E. V. Vostrikova, Yu.V. Panyushkina, A.K. Yakusheva, P. Pilipenko, M.A. Epalintseva
The article presents the analyzed anamnestic data of 118 patients with Parkinson's disease (40 men and 78 wo¬men). Patients were divided into groups according to the severity of the disease. The number of patients with the first degree of severity was 11 people, with the second — 36 people, with the third — 62 people, with the fourth degree — 9 people. According to the results of the study, it was found that non-motor symptoms were detected before the onset of motor symptoms of Parkinson's disease, and were also present in 100% of patients. Therefore, the understanding of the non-motor symptoms' pathology in this disease, and providing an early, accurate diagnosis and appropriate therapeutic approach at the prodromal stage, remains a major and challenging task in the treatment of Parkinson's disease.
本文分析了118例帕金森病患者(男性40例,女性78例)的记忆资料。根据病情的严重程度,病人被分成不同的组。1级11人,2级36人,3级62人,4级9人。根据研究结果,非运动症状在帕金森病的运动症状出现之前就已经被发现,并且在100%的患者中也存在。因此,了解该病的非运动症状病理,在前驱期提供早期、准确的诊断和适当的治疗方法,仍然是帕金森病治疗的一项重要而具有挑战性的任务。
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引用次数: 0
FEATURES OF THE NEW CORONAVIRUS INFECTION IN CHILDREN 新型冠状病毒感染儿童的特点
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-1-18-22
G. S. Karpovich, I. V. Kuimova, A. Shestakov, T. V. Komissarova, M. A. Mihajlenko, Yu S Serova, Yu.S. Schekin
A prospective observation of 524 pediatric patients with laboratory-verified coronavirus infection was carried out. The main epidemiological data were analyzed, including the age structure, as well as the features of the clinical course of the disease. Most often, the clinical picture was dominated by symptoms of ARVI: hyperemia of the fauces — in 501 patients (95.6% of cases), while fever — in 412 (78.6%), and cough — in 89 (16.9%). The involvement of the gastrointestinal tract was manifested mainly by the symptoms of acute gastroenteritis, and was observed in 37.6% of cases, specifically diarrhea — 21.2%, vomiting — 16.5%, abdominal pain syndrome — 9.2%. These manifestations were significantly more frequently recorded in patients under one year, as well as children of the first three years of life (p ≤ 0.05).
对524例经实验室证实的小儿冠状病毒感染患者进行前瞻性观察。分析主要流行病学资料,包括年龄结构、临床病程特点等。大多数情况下,临床表现以ARVI的症状为主:501例(95.6%)患者的水龙头充血,412例(78.6%)患者发烧,89例(16.9%)患者咳嗽。累及胃肠道主要表现为急性胃肠炎,占37.6%,其中腹泻占21.2%,呕吐占16.5%,腹痛综合征占9.2%。1岁以下患者和3岁以下儿童出现上述症状的频率明显高于其他患者(p≤0.05)。
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引用次数: 0
STRUCTURAL AND FUNCTIONAL CHARACTERISTICS OF THE LIVER IN MIXED HCV+HBV INFECTION 混合hcv + hbv感染的肝脏结构和功能特征
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-3-16-21
D. Nepomnyashchikh, O. Postnikova, E. Vinogradova, E. E. Abramova, T. Suvorova, Y. Ovechkina, A. Tereshchenko
Introduction. The study of HCV + HBV mixed hepatitis is a serious problem due to the varied and more severe clinical picture compared to mono-infection, as well as the presence of seronegative variants of HBV infection. In addition, mixed infection is characterized by a more rapid progression of the pathological process to cirrhosis of the liver. The frequency of mixed infection detection has been increasing in recent years. Aim of the research. To study the structural and functional characteristics of the liver in mixed infection with HCV + HBV. Materials and methods. A comprehensive clinical and pathomorphological study of HCV + HBV mixed infection was carried out, which included 112 patients with markers of chronic hepatitis C and B. The age of the patients ranged from 16 to 69 years, 68 men and 44 women. In a clinical study, in addition to a detailed study of the anamnesis, blood biochemical parameters were tested: the level of aminotransferases (AlAT and AST), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGTP), bilirubin, total protein, albumin, cholesterol, glucose. The system of hemostasis was studied: prothrombin time, prothrombin index; peripheral blood parameters were determined — hemoglobin, erythrocytes, platelets, leukocytes, ESR. Results. With a high activity of the infectious process, a tendency was found to increase in the surface density of the granular cytoplasmic reticulum in comparison with low activity indicators, which led to rather high ratio of organelles of the protein-synthesizing compartment and mitochondria to the cytoplasm of hepatocytes. In addition, with a high degree of mixed hepatitis activity, a slightly higher structural density of lipid inclusions and a lower volumetric density of cytoplasm devastation zones were found. In general, most of the main cytoplasmic organelles of hepatocytes in chronic HCV + HBV mixed infection had similar indicators of structural density, regardless of the process activity. Conclusion. Mixed HCV + HBV infection is characterized by phenotypic heterogeneity of the hepatocyte population associated with a variety of cytopathic effects caused by complex viral exposure. Hepatitis C RNA virus attacks predominantly cytoplasmic organelles while preserving the nucleus, hepatitis B DNA virus causes degradation of the nuclear compartment with the formation of a ring-shaped nucle cricoid that can be detected by light-optics. The combination of RNA and DNA hepatitis C and B viruses caused phenotypic heterogeneity of the hepatocyte population. Hepatitis C RNA virus caused the degradation of the cytoplasmic compartment of the cell, hepatitis B DNA virus, first of all, caused the modification of the nucleus.
介绍。HCV + HBV混合肝炎的研究是一个严重的问题,因为与单一感染相比,HCV + HBV混合肝炎的临床表现多种多样,而且更为严重,而且HBV感染存在血清阴性变体。此外,混合感染的特点是病理过程进展到肝硬化的速度更快。近年来,混合感染的检测频率有所增加。研究的目的。目的:探讨HCV + HBV混合感染患者肝脏的结构和功能特点。材料和方法。对HCV + HBV混合感染的临床和病理形态学进行全面研究,纳入112例慢性丙型肝炎和乙型肝炎标志物患者,年龄16 ~ 69岁,男性68例,女性44例。在临床研究中,除了对患者进行详细的研究外,还检测了血液生化指标:转氨酶(AlAT、AST)、碱性磷酸酶(AP)、γ -谷氨酰转肽酶(GGTP)、胆红素、总蛋白、白蛋白、胆固醇、葡萄糖水平。研究止血系统:凝血酶原时间、凝血酶原指数;测定外周血参数:血红蛋白、红细胞、血小板、白细胞、血沉。结果。在感染过程活性高的情况下,颗粒细胞质网的表面密度比活性低的指标有增加的趋势,这导致肝细胞的蛋白质合成室和线粒体细胞器与细胞质的比例较高。此外,在高度混合肝炎活动的情况下,发现脂质包涵体的结构密度略高,细胞质破坏带的体积密度较低。一般而言,无论过程活性如何,慢性HCV + HBV混合感染的肝细胞大多数主要细胞质细胞器具有相似的结构密度指标。结论。混合HCV + HBV感染的特点是与复杂病毒暴露引起的各种细胞病变效应相关的肝细胞群的表型异质性。丙型肝炎RNA病毒主要攻击细胞器,同时保留细胞核,乙型肝炎DNA病毒导致核室降解,形成环状核,可通过光光学检测到。丙型肝炎病毒和乙型肝炎病毒的RNA和DNA结合引起肝细胞群的表型异质性。丙肝RNA病毒引起细胞细胞质隔室的降解,乙肝DNA病毒首先引起细胞核的修饰。
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引用次数: 0
EFFECTIVENESS AND SAFETY OF KETAMINE ANALGOSEDATION IN THE ACUTE PERIOD OF SEVERE BURN INJURY 重度烧伤急性期氯胺酮镇痛镇静的有效性和安全性
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-4-51-54
R.I. Seliverstov, I. Samatov, D.N. Vostrikov, V. Dudin, D. Konovalov, E. Vereshchagin
This work is devoted to the topical issue of surgery and anesthesiology, namely, anesthesia and sedation in circulatory shock, in particular, burn shock. The aim of the study was to evaluate the effectiveness and safety of ketamine analgosedation in the acute period of severe burn injury. The pilot study included 9 adult patients aged 15–70 years having a severe burn injury with an area of >40% of the body surface, who were in the intensive care unit for more than 3 days. Intensive care in burn shock was carried out according to the accepted national clinical guidelines. Ketamine after a preliminary bolus (0.25–0.5 mg/kg) was administered through a perfusor (up to 25 mg/h). According to the totality of clinical and laboratory data (dynamics of lactate level, pH, BE, urination rate), shock was controled by the end of the second day from the moment of injury. The assessment of the level of sedation on the RASS scale in patient treated with ketamine showed on average at the level of 2 points during the observation period, the need for narcotic analgesics was limited by the need to perform surgical procedures. Side effects of the use of ketamine (intestinal paresis, vomiting, development of delirium) were not observed. Thus, we can conclude that ketamine analgosedation is safe and effective in burn shock.
这项工作致力于外科和麻醉学的主题问题,即循环休克中的麻醉和镇静,特别是烧伤休克。本研究旨在评价氯胺酮镇痛镇静在严重烧伤急性期的有效性和安全性。初步研究纳入9例年龄15-70岁的严重烧伤患者,烧伤面积为体表面积的40%,在重症监护室治疗3天以上。烧伤休克的重症监护按照公认的国家临床指南进行。氯胺酮初始丸(0.25-0.5 mg/kg)后通过灌注器(高达25 mg/h)给予。根据临床和实验室数据(乳酸水平、pH、BE、排尿率的动态),休克在受伤第2天结束时得到控制。氯胺酮治疗患者的RASS镇静水平评估显示,观察期内平均在2分水平上,麻醉镇痛药物的需要受到手术需要的限制。未观察到氯胺酮使用的副作用(肠麻痹、呕吐、谵妄的发生)。由此可见,氯胺酮镇静治疗烧伤休克是安全有效的。
{"title":"EFFECTIVENESS AND SAFETY OF KETAMINE ANALGOSEDATION IN THE ACUTE PERIOD OF SEVERE BURN INJURY","authors":"R.I. Seliverstov, I. Samatov, D.N. Vostrikov, V. Dudin, D. Konovalov, E. Vereshchagin","doi":"10.31549/2541-8289-2022-6-4-51-54","DOIUrl":"https://doi.org/10.31549/2541-8289-2022-6-4-51-54","url":null,"abstract":"This work is devoted to the topical issue of surgery and anesthesiology, namely, anesthesia and sedation in circulatory shock, in particular, burn shock. The aim of the study was to evaluate the effectiveness and safety of ketamine analgosedation in the acute period of severe burn injury. The pilot study included 9 adult patients aged 15–70 years having a severe burn injury with an area of >40% of the body surface, who were in the intensive care unit for more than 3 days. Intensive care in burn shock was carried out according to the accepted national clinical guidelines. Ketamine after a preliminary bolus (0.25–0.5 mg/kg) was administered through a perfusor (up to 25 mg/h). According to the totality of clinical and laboratory data (dynamics of lactate level, pH, BE, urination rate), shock was controled by the end of the second day from the moment of injury. The assessment of the level of sedation on the RASS scale in patient treated with ketamine showed on average at the level of 2 points during the observation period, the need for narcotic analgesics was limited by the need to perform surgical procedures. Side effects of the use of ketamine (intestinal paresis, vomiting, development of delirium) were not observed. Thus, we can conclude that ketamine analgosedation is safe and effective in burn shock.","PeriodicalId":342613,"journal":{"name":"Sibirskij medicinskij vestnik","volume":"287 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115242825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
DETERMINATION OF THE EFFECTIVENESS OF PERSONALIZED PHARMACOTHERAPY FOR ARTERIAL HYPERTENSION IN DIFFERENT CENTRAL NERVOUS SYSTEM ACTIVITY 确定不同中枢神经系统活动的个体化药物治疗高血压的有效性
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2021-4-40-47
G. Usenko, N. P. Velichko, A. Uskov, L. Makarova, D.A. Makhmudyan
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引用次数: 0
PATHOGENETIC FEATURES OF THE INFLUENCE OF A PAST CORONAVIRUS INFECTION IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME 既往冠状病毒感染对多囊卵巢综合征妇女影响的发病特点
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2023-7-2-60-67
A. V. Usova, T. M. Sokolova, K. Makarov, T. V. Kiseleva, E.N. Usolkina
From July 1, 2022, restrictions related to the spread of COVID-19 were lifted in Russia. But until now, according to experts, COVID-19 remains one of the most important medical problems for the global community. In 2023, 11 thousand people died from COVID-19 in the world, about 3 million were infected. There are cases known for complications from other organ systems in patients with COVID-19. However, in the general population, the course of COVID-19 is more severe in people with dyslipidaemia, obesity and hypertension. Often, these comorbidities are associated with polycystic ovary syndrome (PCOS). It is possible that women with PCOS will experience more severe clinical manifestations in the future. For 2020–2023 many women reported experiencing menstrual irregularities for the first time, which raised concerns about the impact of SARS-CoV-2 on reproductive function. There are currently insufficient clinical and statistically significant data to establish the causes of these disorders. This material is devoted to the analysis of the probable causes of menstrual irregularities in women with PCOS after a coronavirus infection: the possible direct effect of SARS-CoV-2 on the organs of the female reproductive system depending on the PCOS phenotype.
从2022年7月1日起,俄罗斯取消了与COVID-19传播有关的限制。但据专家介绍,到目前为止,COVID-19仍然是国际社会最重要的医疗问题之一。2023年,全球有1.1万人死于COVID-19,约300万人受到感染。已知的病例中,COVID-19患者有其他器官系统的并发症。然而,在一般人群中,患有血脂异常、肥胖和高血压的人群的COVID-19病程更为严重。通常,这些合并症与多囊卵巢综合征(PCOS)有关。多囊卵巢综合征的女性在未来可能会出现更严重的临床表现。2020-2023年,许多女性报告首次出现月经不规律,这引发了人们对SARS-CoV-2对生殖功能影响的担忧。目前没有足够的临床和统计上有意义的数据来确定这些疾病的原因。本材料致力于分析冠状病毒感染后多囊卵巢综合征女性月经不规律的可能原因:SARS-CoV-2对女性生殖系统器官的可能直接影响取决于多囊卵巢综合征的表型。
{"title":"PATHOGENETIC FEATURES OF THE INFLUENCE OF A PAST CORONAVIRUS INFECTION IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME","authors":"A. V. Usova, T. M. Sokolova, K. Makarov, T. V. Kiseleva, E.N. Usolkina","doi":"10.31549/2541-8289-2023-7-2-60-67","DOIUrl":"https://doi.org/10.31549/2541-8289-2023-7-2-60-67","url":null,"abstract":"From July 1, 2022, restrictions related to the spread of COVID-19 were lifted in Russia. But until now, according to experts, COVID-19 remains one of the most important medical problems for the global community. In 2023, 11 thousand people died from COVID-19 in the world, about 3 million were infected. There are cases known for complications from other organ systems in patients with COVID-19. However, in the general population, the course of COVID-19 is more severe in people with dyslipidaemia, obesity and hypertension. Often, these comorbidities are associated with polycystic ovary syndrome (PCOS). It is possible that women with PCOS will experience more severe clinical manifestations in the future. For 2020–2023 many women reported experiencing menstrual irregularities for the first time, which raised concerns about the impact of SARS-CoV-2 on reproductive function. There are currently insufficient clinical and statistically significant data to establish the causes of these disorders. This material is devoted to the analysis of the probable causes of menstrual irregularities in women with PCOS after a coronavirus infection: the possible direct effect of SARS-CoV-2 on the organs of the female reproductive system depending on the PCOS phenotype.","PeriodicalId":342613,"journal":{"name":"Sibirskij medicinskij vestnik","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122359609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PROGNOSTIC ROLE OF BREATHING PARAMETERS IN THE DEVELOPMENT OF ARRHYTHMIAS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME AND CHRONIC HEART FAILURE 呼吸参数在阻塞性睡眠呼吸暂停综合征和慢性心力衰竭患者心律失常发展中的预后作用
Pub Date : 1900-01-01 DOI: 10.31549/2541-8289-2022-6-3-35-42
A. Yakovlev, S. Shilov, N. Yakovleva, E. Berezikova, R. S. Chernyshev, K. S. Sakhonchik, M. Kessler
Abstract. Obstructive sleep apnea syndrome (OSAS) is increasingly being considered as a factor associated with the development of nocturnal arrhythmias, as well as an increased risk of sudden cardiac death. The prevalence of OSA reaches 5-7% in the adult population. The prognostic role of pathological breathing patterns has not been sufficiently investigated, and therefore further study of the pathogenesis of arrhythmias for the subsequent intensification of therapeutic measures is promising. Aim of the Research. To study the prognostic significance of individual breathing parameters in different sleep phases for the development of atrial fibrillation and ventricular arrhythmias in patients with obstructive sleep apnea syndrome (OSAS) and chronic heart failure (CHF) with preserved ejection fraction (EF). Materials and methods. 86 men with moderate and severe OSAS (with an apnea/hypopnea index (AHI) >15 per hour) were examined. To diagnose OSAS, all patients underwent a polysomnographic study of night sleep. The severity of obstructive respiratory disorders during sleep was assessed by the apnea/hypopnea index for the total period of sleeping. Using polysomnography, we additionally investigated the following parameters of respiratory disturbances during the night sleep period: index of obstructive apnea/hypopnea selectively in REM sleep (AHIobsREM); index of respiratory distress syndrome for the entire period of sleep (IRDS); index of respiratory distress syndrome in the REM sleep phase (IRDS REM); average saturation per night; desaturation index for the total period of sleep; desaturation index in REM sleep. The observation period was 12 months, during which the presence of atrial fibrillation paroxysms lasting more than 30 s and the development of high-grade ventricular arrhythmias (III-V class according to Ryan) were assessed. Results. In the course of the study, a number of breathing parameters during the night time sleep (IAHobs, IAHobsREM, IRDS, IRDS REM) significantly correlated with the development of the studied cardiac arrhythmias. The most significant prognostic role has been stated for obstructive sleep apnea registered in the REM sleep phase. Conclusion. Breathing parameters during nighttime sleeping (IAHobs, IAHobs REM, IRDS, IRDS REM), which characterize the severity of OSAS are independent predictors of the development of paroxysmal atrial fibrillation and high-grade ventricular extrasystole in patients with OSAS and CHF with preserved EF. The results obtained make it possible to use these sleep parameters in the future in stratifying the risk of arrhythmias and determining treatment tactics in this cohort of patients.
摘要阻塞性睡眠呼吸暂停综合征(OSAS)越来越被认为是与夜间心律失常的发生以及心源性猝死风险增加相关的一个因素。OSA的患病率在成人中达到5-7%。病理性呼吸方式的预后作用尚未得到充分的研究,因此进一步研究心律失常的发病机制以加强治疗措施是有希望的。研究目的:探讨不同睡眠阶段个体呼吸参数对保留射血分数(EF)的阻塞性睡眠呼吸暂停综合征(OSAS)和慢性心力衰竭(CHF)患者心房颤动和室性心律失常的预后意义。材料和方法。对86例中重度OSAS患者(呼吸暂停/低通气指数(AHI) >15 /h)进行了检查。为了诊断OSAS,所有患者都进行了夜间睡眠多导睡眠图研究。通过睡眠总时间的呼吸暂停/低通气指数评估睡眠期间阻塞性呼吸障碍的严重程度。利用多导睡眠图,我们进一步研究了夜间睡眠期间呼吸障碍的以下参数:选择性快速眼动睡眠中阻塞性呼吸暂停/低通气指数(AHIobsREM);全睡眠期呼吸窘迫综合征指数(IRDS);快速眼动睡眠阶段呼吸窘迫综合征指数(IRDS REM);每晚平均饱和度;总睡眠时间的去饱和指数;快速眼动睡眠的去饱和指数观察期为12个月,在此期间评估房颤发作持续30 s以上的情况和高级室性心律失常的发展情况(Ryan分级为III-V级)。结果。在研究过程中,夜间睡眠期间的多项呼吸参数(IAHobs, IAHobsREM, IRDS, IRDS REM)与所研究的心律失常的发生显著相关。阻塞性睡眠呼吸暂停在快速眼动睡眠阶段最重要的预后作用。结论。夜间睡眠期间的呼吸参数(IAHobs, IAHobs REM, IRDS, IRDS REM)是表征OSAS严重程度的独立预测因素,也是OSAS和CHF保留EF患者发生阵发性心房颤动和高级别室性心动过速的独立预测因素。所获得的结果使得在未来使用这些睡眠参数分层心律失常的风险和确定治疗策略成为可能。
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Sibirskij medicinskij vestnik
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