AORTOKORONAR SHUNTLASHDAN KEYINGI BEMORLARDA INTENSIV TERAPIYANI TAKOMILLASHTIRISH (ADABIYOTLAR SHARHI)
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yurak ishemik kasalligi, aortokoronar shuntlash, sun'iy qon aylanish, sitokinlar, ulinitatin, tizimli yallig'lanish reaksiyasi sindromi##article.abstract##
Katta yoshli aholi o‘limining sabablari orasida yurak ishemik kasalligi (YIK) yetakchi o‘rinlardan birini egallaydi. Yurak ishemik kasalligini davolash bo‘yicha xalqaro va Rossiya tavsiyalari aortokoronar shuntlash (AKSh) kabi toj tomirlarni jarrohlik revaskulyarizatsiyasiga birgalikda yondashuvni talab qiladi. Umuman olganda, aortokoronar shuntlash 2 turdagi jarrohlik aralashuvlaridan iborat bo‘lib, ularning orasidagi farq sun’iy qon aylanish tizimidan (SQA) foydalanib, paralel SQA bilan birga to‘xtatilmagan yurakda hamda yurakni to‘xtatib va ishlaydigan yurakda operatsiya qilishdir. Jarrohlik aralashuvlari va sun’iy qon aylanish — bu komplement tizimini faollashtirish va sitokinlarning chiqarilishini boshlash orqali tizimli yallig‘lanish reaksiyasini keltirib chiqaradigan tabiiy holatdir. IL-6, IL-1b va o‘sma nekrozi faktori alfa (TNF-a) yallig‘lanish reaksiyalarining o‘tkir bosqichining asosiy vositachisidir. Tahlil shuni ko‘rsatadiki, operatsiyadan keyingi erta davrda ulinastatinni qo‘llash neytrofillarning sekvestratsiyasi va faollashuvini pasayishini hamda sitokin darajasining operatsiyadan keyingi normal o‘sishini susaytiradi, tizimli yallig‘lanish reaksiyasi sindromini, o‘pka kapillyarlarining o‘tkazuvchanligini va operatsiyadan keyingi o‘pka shishini kamaytiradi.
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