spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.5922/2223-2427-2024-9-2-6spractice-474Research ArticleОБЗОРЫ ЛИТЕРАТУРЫПредоперационная оценка риска кровотечения у кардиохирургических пациентовPreoperative bleeding risk assessment in cardiac surgery patientshttps://orcid.org/0009-0005-4868-8400ЗюзинВ. С.ZyuzinV. S.

Вадим Сергеевич Зюзин, заведующий трансфузиологическим кабинетом

236035, Калининградская область, пос. Родники, Калининградское шоссе, 4а

Vadim S. Zyuzin, Head of the Transfusion Unit

4a Kaliningradskoye Shosse, Rodniki, Kaliningrad region, 236035

zuruss@mail.ruФедеральный центр высоких медицинских технологийРоссияFederal Centre of High Medical TechnologiesRussian Federation202416072024028096Copyright © Зюзин В.С., 20242024Зюзин В.С.Zyuzin V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/474

Цель. Изучить роль шкал оценки риска кровотечения, индивидуального и наследственного анамнеза, анализа предыдущих кровотечений и их влияния на риск всех возможных осложнений, в том числе и летального исхода, у взрослых пациентов после кардиохирургического вмешательства по сравнению с рутинной тактикой.Материалы и методы. Поиск публикаций проводился с использованием базы данных PubMed, Transfusion Evidence Library, eLibrary.ru за период с 2019 по 2023 г. Поисковые термины включали слова: шкалы оценки риска кровотечения в кардиохирургии взрослых, предоперационная анемия в кардиохирургии взрослых, переливание эритроцитсодержащих компонентов в кардиохирургии взрослых. Исключение дублирующих статей осуществлялось вручную. Дополнительный поиск проводился среди списков литературы отобранных публикаций.Материалы и методы. Поиск публикаций проводился с использованием базы данных PubMed, Transfusion Evidence Library, eLibrary.ru за период с 2019 по 2023 г. Поисковые термины включали слова: шкалы оценки риска кровотечения в кардиохирургии взрослых, предоперационная анемия в кардиохирургии взрослых, переливание эритроцитсодержащих компонентов в кардиохирургии взрослых. Исключение дублирующих статей осуществлялось вручную. Дополнительный поиск проводился среди списков литературы отобранных публикаций.Результаты. Всего было найдено 2011 публикаций. На первом этапе отбора учитывали клинические исследования, метаанализы, рандомизированные контролируемые исследования, обзоры и регулярные обзоры без языковых ограничений на основе содержания аннотации. На втором этапе для исследований, прошедших предыдущий этап, решение принималось на основании оценки полнотекстового варианта, в котором были представлены последствия предоперационной анемии, послеоперационных кровотечений, трансфузионной терапии у взрослых кардиохирургических пациентов. В итоге в данный описательный обзор были включены 40 публикаций.Заключение. Предоперационная оценка риска кровотечения является мультимодальной междисциплинарной проблемой, требующей пациентоориентированного подхода. Она должна начинаться еще на подготовительном этапе и требует участия врачей первичного звена, кардиологов, хирургов, анестезилогов-реаниматологов, врачей лабораторной диагностики и трансфузиологов. Краеугольным камнем является сбор индивидуального и семейного анамнеза. Получение информации, основанной на вовлечении пациента путем задавания наводящих на размышления вопросов, использовании шкал оценки риска кровотечения, анализе данных о предыдущих кровотечениях, подкрепленное данными лабораторных тестов, представляет собой наиболее научный подход к разработке индивидуального плана ведения пациента с риском кровотечения.

Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications.Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review.Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding.

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The authors declare that there are no conflicts of interest present.