Abstract
Inroduction. Systemic inflammatory response (SIR) is an obligatory manifestation of operational stress affecting the functional status of patients, which is important to consider in persons with comorbid pathology.Aim. Evaluation of the relationship between pulmonary volemia and SIR indicators in patients with comorbidity of chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) after coronary artery bypass grafting (CABG).Materials and methods. The study included 76 IHD patients aged 53 to 77 years who underwent CABG. Among the surveyed, 2 groups were identified: 39 patients with IHD and 37 – with a combination of IHD and COPD. The following indices were measured by transpulmonary thermodilution: pulmonary blood volume (PBV), extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), pulmonary shunt fraction (Qs/Qt). Determined the concentration in the blood of interleukin 6 and 10 (IL-6, IL-10), tumor necrosis factor-alpha (TNF-α); transforming growth factor-beta1 (TGFβ1), NLR - the ratio of neutrophils to lymphocytes; PLR – the ratio of platelets to lymphocytes.Results. The most pronounced disturbances in the water balance of the lungs, manifested by an increase in EVLWI, PVPI and Qs/Qt were recorded in patients with comorbidity of COPD and IHD immediately after withdrawal from cardiopulmonary bypass. The PBV level at all measurement points in patients with COPD was lower, which indicated the prevalence of right ventricular failure. SIR on operational stress in this category of patients was manifested by the discoordination of the cytokine profile: a sharp increase in the concentration of IL-6 and IL-10 against the background of a relatively stable level of TNFα and TGF-β1, as well as an increase in NLR and PLR.Conclusion. The unidirectional response of pulmonary volemia and SIR indicators to operational stress indicates the pathophysiological relationship of the studied phenomena.
Highlights
an obligatory manifestation of operational stress affecting the functional status of patients
important to consider in persons with comorbid pathology
The following indices were measured by transpulmonary thermodilution
Summary
Федеральное государственное автономное образовательное учреждение высшего образования. «Дальневосточный федеральный университет», Школа Биомедицины, 690920, г. Федеральное государственное бюджетное образовательное учреждение высшего образования. Оценка взаимосвязи индикаторов легочной волемии и СВР у больных с коморбидностью хронической обструктивной болезни легких (ХОБЛ) и ишемической болезни сердца (ИБС) в процессе выполнения коронарного шунтирования (КШ). Определяли концентрацию в крови интерлейкина 6 и 10 (IL-6, IL-10), фактора некроза опухоли-альфа (TNF-α); трансформирующего фактора роста-бета (TGF-β1), NLR − отношение нейтрофилов к лимфоцитам; PLR – отношение тромбоцитов к лимфоцитам. Наиболее выраженные нарушения водного баланса легких, проявляющиеся ростом ИВСЛ, ИПЛС и Qs/Qt фиксировались у больных с коморбидностью ХОБЛ и ИБС сразу после отхода от искусственного кровообращения. Уровень ЛОК во всех точках измерения у больных ХОБЛ был ниже, что свидетельствовало о преобладании правожелудочковой недостаточности. Однонаправленная реакция индикаторов легочной волемии и СВР на операционный стресс указывает на патофизиологические взаимосвязи изучаемых явлений.
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