microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2018-17-1-25-31microcirculation-147Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ (КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ)ORIGINAL ARTICLES (CLINICAL INVESTIGATIONS)О различиях в гемодинамике большого и малого кругов кровообращения при метаболическом ацидозе в послеоперационном периоде кардиохирургических вмешательствAbout differences in systemic and pulmonary circulation in the cases of metabolic acidosis after cardio surgeryМаричевА. О.MarichevA. O.marichevalexandr@gmail.comВолдаеваО. А.VoldaevaO. A.voldaeva22@gmail.comГребенникВ. К.GrebennikV. K.vadikdoc@mail.ruКурсковаЕ. С.KurskovaE. S.ekurskova86@gmail.comМякшинС. В.MyakshinS. V.myakshin_sv@mail.ruСавельеваА. А.SavelevaA. A.alexa.savelyeva@gmail.comТашхановД. М.TashkhanovD. M.tashkhandm@gmail.comМазурокВ. А.MazurokV. A.vmazurok@mail.ruБаутинА. Е.BautinA. E.abautin@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research Centre of the Ministry of Healthcare of the Russian FederationRussian Federation2018300320181712531Copyright © Маричев А.О., Волдаева О.А., Гребенник В.К., Курскова Е.С., Мякшин С.В., Савельева А.А., Ташханов Д.М., Мазурок В.А., Баутин А.Е., 20182018Маричев А.О., Волдаева О.А., Гребенник В.К., Курскова Е.С., Мякшин С.В., Савельева А.А., Ташханов Д.М., Мазурок В.А., Баутин А.Е.Marichev A.O., Voldaeva O.A., Grebennik V.K., Kurskova E.S., Myakshin S.V., Saveleva A.A., Tashkhanov D.M., Mazurok V.A., Bautin A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/147

Цель исследования - оценить изменения гемодинамики большого и малого кругов кровообращения при развитии метаболического ацидоза (МетАц) в раннем послеоперационном периоде коронарного шунтирования в условиях искусственного кровообращения. Материал и методы. Выполняли анализы кислотно-основного состояния крови и измерение гемодинамики методом термодилюции 114 пациентам (441 проба крови). Результаты. МетАц ассоциирован с повышением сосудистого сопротивления малого круга, увеличением давления в легочной артерии и работы правого желудочка. Эти изменения характерны и для ацидоза на фоне СВО, и для ацидоза, вызванного СМСВ, несмотря на разнонаправленное влияние указанных типов на гемодинамический профиль большого круга кровообращения. Заключение. Подтверждено влияние МетАц на тонус сосудов легких. Изменения в большом круге вызваны снижением общего периферического сопротивления сосудов при СВО или падением сердечного выброса при СМСВ, но не изменением pH.

Objective - to evaluate changes in systemic and pulmonary circulation in the cases of metabolic acidosis (MetAcid) after CABG. Material and metods. Study enrolled 114 patients. In the postoperative period we sampled arterial and mixed venous blood for acid-base analysis. At the same time point we measured a hemodynamic parameters). Results. We found opposite changes in systemic circulation in the cases with different types of MetAcid. SIR was associated with vasoplegia and increased stroke volume (SV). The cases of AHF showed decrease in SV and vasoconstriction. We found one-direction changes in pulmonary circulation in the cases with different types of MetAcid. There were a tendency toward an increase in the pulmonary vascular resistance, raise in the PAPmean in both subgroups.

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