clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2024-102-11-12-854-861clinmed-987Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSРеспираторные исходы и предикторы развития дыхательной недостаточности при хирургической реваскуляризации миокарда у пациентов, перенесших COVID-19Respiratory outcomes and predictors of respiratory failure development during surgical myocardial revascularisation in patients who underwent COVID-19https://orcid.org/0000-0003-3008-5124ЕрмаковВ. С.ErmakovV. S.

Ермаков Валерий Сергеевич — врач-сердечно-сосудистый хирург, 2 -е кардиохирургическое отделение

Санкт-Петербург

Valerii S. Ermakov — cardiovascular surgeon, 2nd Cardiac Surgery Department

St. Petersburg

evs10031994@gmail.comhttps://orcid.org/0000-0002-6337-104XКравчукВ. Н.KravchukV. N.

Кравчук Вячеслав Николаевич — д-р мед. наук, профессор, заведующий кафедрой сердечно-сосудистой хирургии ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России; профессор первой кафедры хирургии (усовершенствования врачей) им. П.А. Куприянова ВМедА им. С.М. Кирова Минобороны России

Санкт-Петербург

Viacheslav N. Kravchuk — Doctor of Medical Sciences, Professor, Head of the Department of Cardiovascular Surgery of the North-Western State Medical University named after I.I. Mechnikоv of the Ministry of Healthcare of Russia; Professor of the First Department of Surgery (Advanced Medical Training) named after P.A. Kupriyanov at the S.M. Kirov Medical Military Academy of the Ministry of Defense of the Russian Federation

St. Petersburg

https://orcid.org/0000-0003-3537-7409ПорембскаяО. Я.PorembskayaO. Ya.

Порембская Ольга Ярославна — канд. мед. наук, доцент кафедры сердечно-сосудистой хирургии

Санкт-Петербург

Olga Ya. Porembskaya — Candidate of Medical Sciences, Associate Professor of the Department of Cardiovascular Surgery

St. Petersburg

ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. Mechnikоv of the Ministry of Healthcare of RussiaRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России; ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны РоссииРоссияNorth-Western State Medical University named after I.I. Mechnikоv of the Ministry of Healthcare of Russia; Military Medical Academy named after S.M. Kirov of the Ministry of Defense of RussiaRussian Federation20241003202510211-12854861Copyright © Ермаков В.С., Кравчук В.Н., Порембская О.Я., 20252025Ермаков В.С., Кравчук В.Н., Порембская О.Я.Ermakov V.S., Kravchuk V.N., Porembskaya O.Y.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/987Цель

Цель. Изучить респираторные исходы и выявить предикторы развития дыхательной недостаточности при хирургической реваскуляризации миокарда у пациентов, перенесших COVID-19.

Материал и методы

Материал и методы. В исследовании проанализированы клинические данные 121 пациента, перенесших плановую хирургическую реваскуляризацию миокарда в период с 2018 по 2022 г. В первую группу отнесены 52 пациента, перенесшие COVID-19 перед операцией в среднем за 3,3 ± 2,3 мес., во вторую группу — 69 пациентов без COVID-19 в анамнезе. Изучались показатели искусственной вентиляции легких и газового состава артериальной крови в интраоперационном и раннем послеоперационном периодах, частота развития дыхательной недостаточности (ДН) и выявлялись предикторы ее развития.

Результаты

Результаты. Пациенты, перенесшие COVID-19 в сравнении с больными, не переносившими инфекцию, отличаются значимо низким индексом оксигенации как в интраоперационном периоде — 258 [184,6; 301] и 384,4 [335; 435] соответственно (p = 0,0002), так в раннем послеоперационном периоде — 228 [174,6; 303,5] и 407,5 [351,4; 462,5] соответственно (p = 0,0019) при коронарном шунтировании на работающем сердце. У пациентов с COVID-19 в анамнезе в 6,6 раз чаще развивается ДН — 23,1% против 4,3%; ОШ 6,6; 95% ДИ 1,76–24,82; p = 0,0038. Предикторами развития ДН являются: тяжесть перенесенного COVID-19 (p = 0,0016), поражение легких во время COVID-19 (p = 0,0083), ДН во время COVID-19 (p = 0,0061), длительность пребывания в ОРИТ во время COVID-19 (p = 0,0002). Зафиксирован один (0,02%) летальный исход на следующие сутки после операции пациента с COVID-19 вследствие острого респираторного дистресс-синдрома (ОРДС).

Выводы

Выводы. Пациенты, перенесшие COVID-19, имеют респираторные нарушения и высокий риск развития дыхательной недостаточности при хирургической реваскуляризации миокарда на работающем сердце. Предикторы развития ДН ассоциированы с клиническим течением COVID-19. Недиагностированный COVID-19 может способствовать развитию ОРДС в раннем послеоперационном периоде.

Objective

Objective. To study respiratory outcomes and identify predictors of respiratory failure development in patients undergoing surgical myocardial revascularization after COVID-19.

Material and methods

Material and methods. The study analyzed clinical data from 121 patients who underwent elective surgical myocardial revascularization from 2018 to 2022. The first group included 52 patients who had COVID-19 prior to surgery, on average 3.3 ± 2.3 months before the operation, while the second group consisted of 69 patients without a history of COVID-19. Indicators of mechanical ventilation and gas composition of arterial blood were studied during the intraoperative and early postoperative periods, the frequency of respiratory failure (RF) was assessed, and predictors of its development were identified.

Results

Results. Patients who had COVID-19 showed significantly lower oxygenation index compared to those without the infection, both in the intraoperative period — 258 [184.6; 301] vs. 384.4 [335; 435] respectively (p = 0.0002), and in the early postoperative period — 228 [174.6; 303.5] vs. 407.5 [351.4; 462.5] respectively (p = 0.0019) during coronary artery bypass grafting on a beating heart. Patients with a history of COVID-19 developed RF 6.6 times more often — 23.1% vs. 4.3%; Odds Ratio (OR) 6.6; 95% Confidence Interval (CI) 1.76–24.82; p = 0.0038. Predictors of RF development included: severity of COVID-19 (p = 0.0016), lung involvement during COVID-19 (p = 0.0083), RF during COVID-19 (p = 0.0061), and duration of stay in the Intensive Care Unit (ICU) during COVID-19 (p = 0.0002). One (0.02%) fatal outcome was recorded the day after surgery in a patient with COVID-19 due to acute respiratory distress syndrome (ARDS).

Conclusions

Conclusions. Patients who have had COVID-19 exhibit respiratory impairments and a high risk of developing respiratory failure during surgical myocardial revascularization on a beating heart. Predictors of RF development are associated with the clinical course of COVID-19. Undiagnosed COVID-19 may contribute to the development of ARDS in the early postoperative period.

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