clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2020-98-8-612-618clinmed-124Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSПервый опыт лечения пациентов с тромбоэмболией легочной артерии, развившейся на фоне COVID-19The first experience of treatment applied to patients with pulmonary embolism that developed on the COVID-19 backgroundhttps://orcid.org/0000-0002-5930-3941ФедоровС. А.FedorovS. A.

Федоров Сергей Андреевич — канд. мед. наук, сердечно-сосудистый хирург  

603950, Нижний Новгород

603005, Нижний Новгород

Sergey A. Fyodorov — MD, PhD, cardiovascular surgeon

603950, Nizhny Novgorod

603005, Nizhny Novgorod

Sergfedorov1991@yandex.ruhttps://orcid.org/0000-0003-1757-5962МедведевА. П.MedvedevA. P.

603950, Нижний Новгород

603005, Нижний Новгород

603950, Nizhny Novgorod

603005, Nizhny Novgorod

https://orcid.org/0000-0002-7241-7070МаксимовА. Л.MaksimovA. L.

603950, Нижний Новгород

603950, Nizhny Novgorod

https://orcid.org/0000-0001-7581-4138БоровковаН. Ю.BorovkovaN. Yu.

603005, Нижний Новгород

603005, Nizhny Novgorod

https://orcid.org/0000-0002-0504-1421СухановаМ. Б.SukhanovaM. B.

603950, Нижний Новгород

603950, Nizhny Novgorod

https://orcid.org/0000-0001-7724-0123ПичугинВ. В.PichuginV. V.

603950, Нижний Новгород

603005, Нижний Новгород

603950, Nizhny Novgorod

603005, Nizhny Novgorod

https://orcid.org/0000-0002-5222-1329ЖуркоС. А.ZhurkoS. A.

603950, Нижний Новгород

603950, Nizhny Novgorod

https://orcid.org/0000-0002-7945-9652ЦелоусоваЛ. М.TselousovaL. M.

603005, Нижний Новгород

603005, Nizhny Novgorod

БричкинЮ. Д.BrichkinYu. D.

603950, Нижний Новгород

603950, Nizhny Novgorod

ГБУЗ НО «Специализированная кардиохирургическая клиническая больница имени академика Б.А. Королева»; ФГБОУ ВО «Приволжский исследовательский медицинский университет» Министерства здравоохранения РФРоссияSpecialized Cardiosurgical Clinical Hospital named after Academician Korolev B.A.; Volga Research Medical UniversityRussian FederationГБУЗ НО «Специализированная кардиохирургическая клиническая больница имени академика Б.А. Королева»РоссияSpecialized Cardiosurgical Clinical Hospital named after Academician Korolev B.A.Russian FederationФГБОУ ВО «Приволжский исследовательский медицинский университет» Министерства здравоохранения РФРоссияVolga Research Medical UniversityRussian Federation202007022021988612618Copyright © Федоров С.А., Медведев А.П., Максимов А.Л., Боровкова Н.Ю., Суханова М.Б., Пичугин В.В., Журко С.А., Целоусова Л.М., Бричкин Ю.Д., 20212021Федоров С.А., Медведев А.П., Максимов А.Л., Боровкова Н.Ю., Суханова М.Б., Пичугин В.В., Журко С.А., Целоусова Л.М., Бричкин Ю.Д.Fedorov S.A., Medvedev A.P., Maksimov A.L., Borovkova N.Y., Sukhanova M.B., Pichugin V.V., Zhurko S.A., Tselousova L.M., Brichkin Y.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/124

Цель исследования: оценить непосредственные результаты лечения тромбоэмболии легочной артерии (ТЭЛА) высокого риска, развившейся на фоне COVID-19, проанализировать особенности клинического течения. Материал и методы. Исследование основано на опыте лечения 3 больных ТЭЛА, развившейся на фоне COVID-19. Все пациенты были мужского пола, средний возраст 41 ± 3,1 года. Верификация первичного диагноза COVID-19 базировалась на положительных результатах полимеразной цепной реакции, дополненная результатами компьютерной томографии. На 5–7-е сутки госпитализации было отмечено развитие ТЭЛА высокого риска. При этом наблюдалось снижение SО2 ниже 85%, РаО2 ниже 76 мм рт. ст., индекс Borg > 8, что потребовало проведения неинвазивной высокопоточной ИВЛ. Катетеризация правых камер сердца катетером Swan –Ganz выявила повышение систолического давления в правом желудочке до 57 ± 1,2 мм рт. ст., диастолического — до 13 ± 0,34 мм рт. ст., также отмечалось повышение давления в легочной артерии до 70 мм рт. ст. Изменения биохимического анализа крови заключались в повышении уровня тропонина I до 0,65 ± 0,14 нг/мл, С-реактивного белка до 5,42 ± 2,1 мг/л, креатинфосфокиназы до 324 ± 23,1 ЕД. Во всех случая было отмечено повышение уровня D-димера, который составил 0,68 ± 0,11 мг/л. Во всех случаях выполнялся системный тромболизис актилизе. Результаты. В срок до 15 ч после тромболитической терапии была отмечена положительная клиническая динамика. Уровень SО2 вернулся к исходным значениям и находился в диапазоне 93–96%, РаО2 — от 86 до 92 мм рт. ст. уже к окончанию первых суток после вмешательства. Средний градиент давления в легочной артерии на момент выписки составил 32 ± 4,12 мм рт. ст., пиковый — 44 ± 5,3 мм рт. ст.

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course. Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO2 below 85%, РаО2 — below 76 mm Hg, Borg index > 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases. Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO2 came back to the initial values and was in the range 93–96% and RaO2 — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.

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