BOLALAR OCHIQ YURAK JARROHLIGI ANESTEZIOLOGIK TA’MINOTIDA KARDIOPROTEKTSIYA: SEVOFLURANNING KLINIK IMKONIYATLARI
Abstrakt
Eksperimental tadqiqotlar shuni ko‘rsatdiki, uchuvchan anestetiklar farmakologik sharoitni keltirib chiqarishi va miokardning shikastlanish darajasini pasaytirishi mumkin, ammo pediatriya amaliyotida klinik ma’lumotlar cheklangan va ziddiyatli bo‘lib qolmoqda. Maqsad. Sun’iy qon aylanishi yordamida ochiq yurakda operatsiya qilingan bolalarda sevofluran va propofol bilan total vena ichi anesteziyasining kardioprotektiv ta’sirini taqqoslash. Usullar. Prospektiv bir markazli tadqiqotga 6 oylikdan 5 yoshgacha bo‘lgan tug‘ma yurak nuqsonlari bor 106 nafar bola kiritilgan bo‘lib, ularga kardioplegik yurak to‘xtashi bilan ochiq yurakda jarrohlik amaliyoti o‘tkazilgan. Bemorlar anesteziya turiga ko‘ra ikki guruhga bo‘lingan: sevofluran (n=53) va propofol (n=53). Operatsiyadan keyingi davrda kardiospetsifik T troponinning maksimal darajasi birlamchi yakuniy nuqta bo‘ldi. Ikkilamchi yakuniy nuqtalarga aritmiyalar chastotasi, gemodinamik barqarorlik ko‘rsatkichlari, exokardiografiya ma’lumotlari, inotrop qo‘llab-quvvatlashga bo‘lgan ehtiyoj, o‘pkaning sun’iy ventilyatsiyasi va intensiv terapiya bo‘limida bo‘lish davomiyligi kiritildi. Natijalar. Barcha kuzatuvlarda operatsiyadan keyin kardiospetsifik troponin T darajasining oshishi qayd etilgan, ammo uning qiymatlari sevofluran guruhida kuzatuvning barcha bosqichlarida sezilarli darajada past bo‘lgan. 3 soatdan so‘ng cTnT miqdori sevofluran guruhida 1,2±0,3 ng/ml va propofol guruhida 1,9±0,4 ng/ml (p<0,05), 8 soatdan so‘ng mos ravishda 1,7±0,4 va 2,6±0,5 ng/ml (p<0,01), 12 soatdan so‘ng 1,5±0,3 va 2,3±0,5 ng/ml (p<0,05), 24 soatdan so‘ng 1,1±0,2 va 1,8±0,3 ng/ml (p<0,05) ni tashkil etdi. Aritmiyalar sevofluran guruhidagi bemorlarning 11,3% da va propofol guruhidagi bemorlarning 26,4% da qayd etilgan (р<0,05). Inotrop qo‘llab-quvvatlashga bo‘lgan ehtiyoj sevofluran qo‘llanilganda pastroq bo‘ldi (15,1% qarshi 32,1%, p<0,05). O‘pkaning sun’iy ventilyatsiyasi vaqti (9,2±3,1 qarshi 13,6±4,4 soat, р<0,01) va OITda bo‘lish davomiyligi (36±10 qarshi 52±14 soat, р<0,05) sevofluran guruhida sezilarli darajada kam bo‘lgan. Exokardiografik ko‘rsatkichlar sevofluran qabul qilgan bemorlarda miokardning sistolik va diastolik funksiyasining tezroq tiklanishini ko‘rsatdi. Xulosa. Bolalarda ochiq yurak operatsiyalarida sevofluranni qo‘llash propofolga nisbatan yaqqol kardioproteksiya bilan bog‘liq bo‘lib, bu miokardning kamroq shikastlanishi, barqaror gemodinamika va operatsiyadan keyingi erta davrda yurakning tezroq funksional tiklanishi bilan namoyon bo‘ladi.
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