Аннотация
Введение. Нарушения свертывающей системы крови занимают одну из основных позиций патогенеза новой коронавирусной инфекции. Характеризуясь непредсказуемым началом, они в большинстве случаев приводят к ранней декомпенсации и смерти пациентов высокого морбидного профиля. Несмотря на наличие большого количества исследований, посвященных вопросам диагностики и лечения, вопросы, касающиеся скрининговой, ранней верификации, остаются нерешенными.
Цель исследования: оценить возможность прогнозирования развития венозных тромбоэмболических осложнений (ВТЭО) в группе пациентов на фоне новой коронавирусной инфекции.
Материал и методы. В основу проводимого исследования лег математический анализ протоколов общедоступных лабораторно-инструментальных методов исследования, взятых из историй болезни пациентов, находящихся на стационарном лечении в ковидных госпиталях Нижнего Новгорода. В общую группу обследуемых респондентов включены 45 человек, которые в последующем были выделены в две подгруппы в зависимости от наличия или отсутствия верифицируемых эпизодов тромбоэмболии легочной артерии (ТЭЛА). Так, первую группу составили 15 больных с развившей массивной ТЭЛА на фоне ковид-ассоциированной полисегментарной пневмонии. Вторая группа была представлена 30 респондентами, перенесшими пневмонию, не осложненную развитием ТЭЛА. Следует отметить, что все больные обладали идентичными объемами поражения паренхимы легкого, имели сходный преморбидный статус и относились к идентичной возрастно-половой группе.
Результаты. В ходе исследования была проведена математическая обработка рассматриваемого материала при помощи теорем Байеса и Фурье, что в конечном счете позволило определить возможность прогнозирования развития тромбоэмболии легочной артерии в отобранной группе больных.
Заключение. Представленные данные позволяют отметить, что выявление высокой вероятности развития ВТЭО по данным общеклинических лабораторных данных у пациентов на фоне новой коронавирусной инфекции позволят своевременно верифицировать правильный диагноз, аргументировать вектор дальнейшего дообследования, а также принять правильный вариант лечения.
Литература
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***
- CDC. 2019 Novel Coronavirus, Wuhan, China. CDC. Available at https://www.cdc.gov/coronavirus/2019-ncov/about/index.html (Accessed January 26, 2020).
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- Bhana N., Goa K.L., McClellan K.J. Dexmedetomidine. Drugs. 2000; 59 (2): 263–8; disc. 269–70. DOI: 10.2165/00003495-200059020-00012
- Guo T.Z., Jiang J.Y., Buttermann A.E., Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology. 1996; 84 (4): 873–81. DOI: 10.1097/00000542-199604000-00015
- Brown E.N., Lydic R., Schiff N.D. General anesthesia, sleep, and coma. N. Engl. J. Med. 2010; 363 (27): 2638–50. DOI: 10.1056/NEJMra0808281
- Nelson L.E., Lu J., Guo T., Saper C.B., Franks N.P., Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003; 98 (2): 428–36. DOI: 10.1097/00000542-200302000-00024
- Djaiani G., Silverton N., Fedorko L., Carroll J., Styra R., Rao V., Katznelson R. Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: A randomized controlled trial. Anesthesiology. 2016; 124 (2): 362–8. DOI: 10.1097/ALN.0000000000000951
- Ji F., Li Z., Nguyen H., Young N., Shi P., Fleming N., Liu H. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation. 2013; 127 (15): 1576–84. DOI: 10.1161/CIRCULATIONAHA.112. 000936. Epub 2013 Mar 19.
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Об авторах
- Коган Лев Петрович, канд. физ.-мат. наук, доцент кафедры физики; ORCID
- Федоров Сергей Андреевич, канд. мед. наук, сердечно-сосудистый хирург; ORCID
- Вольвач Александр Евгеньевич, д-р физ.-мат. наук, заместитель директора по научной работе;
ORCID
- Гордецов Александр Сергеевич, д-р мед. наук, профессор, заведующий кафедрой общей химии;
ORCID
- Красникова Ольга Владимировна, канд. биол. наук, доцент кафедры общей химии; ORCID
- Чигинев Владимир Александрович, д-р мед. наук, сердечно-сосудистый хирург; ORCID
- Гришина Наталья Игоревна, клинический ординатор; ORCID