Koronarna balon angioplastika i parenteralna antitrombocitna terapija kod intraoperativnog akutnog infarkta miokarda u opštoj hirurgiji: rizici i korist primenjene terapije

  • Vojislava C. Nešković Military Medical Academy, Clinic for Anesthesiology and Critical Care, University of Defence, Faculty of Medicine of the Military Medical Academy
  • Slobodan D. Obradović Military Medical Academy, Clinic for Emergency and Internal Medicine, University of Defence, Faculty of Medicine of the Military Medical Academy
  • Ana V. Popadić Military Medical Academy, Clinic for Anesthesiology and Critical Care
  • Nenad B. Nikolić Military Medical Academy, Clinic for Anesthesiology and Critical Care
  • Dušica Stamenković Military Medical Academy, Clinic for Anesthesiology and Critical Care; University of Defence, Faculty of Medicine of the Military Medical Academy
  • Zoran R. Kostić Military Medical Academy, Clinic for General Surgery; University of Defence, Faculty of Medicine of the Military Medical Academy,
DOI: https://doi.org/10.2298/VSP170503082N
Ključne reči: perioperativni period;, hirurgija digestivnog sistema, procedure;, infarkt miokarda;, angioplastika, balonska;, tirofiban

Sažetak


Uvod. Kardiovaskularne komplikacije predstavljaju jedan od najvažnijih faktora rizika koji utiče na perioperativni morbiditet i ishod lečenja kod bolesnika sa nekardio­hi­rur­škim operacijama. Ovde prikazujemo bolesnika sa intraope­rativnim akutnim infarktom miokarda i elevacijom ST-segmenta (STEMI) koji je nastao tokom abdominalne hirurške intervencije. U njegovom zbrinjavanju urađena je perkutana balon dilatacija i primenjena intravenska anti­trombocitna terapija. Prikaz slučaja. Bolesnik, star 62 go­dine, bez prethodnih kardiovaskularnih tegoba, podvrgnut je hirurškoj intervenciji u abdomenu. Intraoperativno, došlo je do razvoja STEMI. Zbog održavanja naglašene hipo­tenzije (srednji arterijski pritisak od 40 mmHg), operacija je ubrzano završena i bolesnik preveden u jedinicu intenzivnog lečenja. Unutar prvog sata od završetka operacije, urađena je koronarografija i u istom aktu balon angioplastika oklu­di­ra­ne desne koronarne arterije. Uključena je infuzija tirofibana u preporučenoj dozi. Tokom prvih 15 sati, kod bolesnika se održavala hemodinamska nestabilnost usled hipovolemije i ekstenzivne drenaže (1500 mL krvi). Narednog dana, drenaža se održavala (dodatnih 600 mL krvi), što je dovelo do naglašene hipotenzije (65/40 mmHg). Postoperativno, ordinirano je 1970 mL krvi, 6 doza trombocita i 840 mL sveže smrznute plazme. Uprkos naglašenoj hemodinamskoj nestabilnosti i krvarenju, primenjena terapija dovela je do potpunog oporavka. Zaključak. Izbor terapije za bolesnike sa perioperativnim STEMI i dalje predstavlja veliki izazov. Kod hirurških bolesnika, kod kojih postoji visok rizik od krvarenja i tromboze, balon dilatacija bez plasiranja stenta, sa primenom peranteralnih antitrombocitnih lekova može biti dobar terapijski pristup. Potreban je individualizovan pristup lečenju, sa procenom rizika i koristi za svakog bolesnika.

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Objavljeno
2021/05/21
Broj časopisa
Vol. 77 Br. 4 (2020): Vojnosanit Pregl
Rubrika
Prikaz bolesnika