Abstract
Introduction. In surgical practice, the presence of comorbid pathology has a significant effect on the course of the postoperative period,
the development of complications, the effect on the prognosis. Existing standards and approaches in surgery should include the
analysis of comorbid diseases when choosing methods of anesthesia, intensive care and tactics of surgical intervention.
Objective. To study the frequency and structure of comorbid pathology in cardiac surgery patients of childhood. Determine the tactics
of the timing of the operation, the diagnosis of related diseases in order to improve medical care for this contingent.
Material and methods. For the period 2013–2017 a prospective study was conducted on 250 children with congenital heart defects
hospitalized in a multidisciplinary clinic – Scientific Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan). All children
underwent standard examinations (echocardiography, electrocardiography, radiography, abdominal ultrasound and neurosonography,
laboratory methods), computed tomography, angiocardiography, genetic methods and bone marrow biopsy according to indications.
Results. In 74.8% of cases newborns and children with cardiosurgical pathology had perinatal encephalopathy; in 45.6% – bronchopulmonary
pathology, 44% – extracardiac malformations, in 26.9% – intrauterine infection; 31.6% – chromosomal and hereditary
metabolic diseases; 1.6% – blood diseases. It was noted that all patients required additional diagnostic and treatment procedures,
there is a high risk of complications and the need for a personified approach to patients. The article the main directions of optimizing
the therapeutic strategy for comorbidity in cardiosurgical patients.
Conclusion. Difficulties in the diagnosis of comorbidities in cardiac surgery patients are not only medical, but also organizational.
Concomitant pathology in cardiac patients required the prolongation of the patient's stay, the widespread use of additional methods
of diagnosis and treatment, and economic costs.
References
- Левченко Е.Г., Таболин В.А., Котлукова Н.П., Шарыкин А.С.,
Ильин В.Н. Течение послеоперационного периода у детей
с ВПС, ассоциированными с генетическими синдромами.
Бюллетень VI Всероссийского съезда сердечно-сосудистых хирургов. М.; 2000.
- Зеленикин М.А., Токмакова К.А. Экстракардиальная
патология, как фактор, определяющий прогноз хирургической коррекции у детей раннего возраста с врожденными пороками сердца. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2012;
1 (4): 13–20.
- Munoz E., Rosner F., Friedman R., Sterman H., Goldstein J.,
Wise L. Financial risk, hospital cost, complications and
comorbidities in medical non-complications and comorbiditystratified
diagnosis-related groups. Am. J. Med. 1988; 84 (5):
933–9.
DOI. 10.1016/0002-9343(88)90074-5
- Муталов А.Г. Коморбидная патология в практике врача
педиатра – особенности диагностики и тактики ведения.
https://medvestnik.ru/content/medarticles/Komorbidnayapatologiya-
v-praktike-vracha-pediatra-osobennosti-diagnostikii-
taktiki-vedeniya.html (дата обращения 11.09.2018).
- Подзолков В.П., Плотникова Л.Р., Амиркулов Б.Д. ВПС у
больных старше 30 лет: структура, результаты хирургического лечения. В кн.: Тезисы докладов на VI Всероссийском
съезде сердечно-сосудистых хирургов, Москва. 5–8 декабря 2000 г. М.; 2000.
- Бокерия Л.А., Самородская И.В., Нуркеев Б.А. Сочетанная патология у взрослых с врожденными пороками
сердца, госпитализированных в кардиохирургический
стационар. Детские болезни сердца и сосудов. 2010; 2:
19–26.
- Gonzalez J.H., Shirali G.S., Atz A.M., Taylor S.N., Forbus G.A.,
Zyblewski S.C. et al. Universal screening for extracardiac
abnormalities in neonates with congenital heart disease.
Pediatr Cardiol. 2009; 30: 269–73.
DOI: 10.1007/s00246-008-9331-z
- Kramer H.H., Majewski F., Trampisch H.J., Rammos S.,
Bourgeois M. Malformation patterns in children with congenital
heart disease. Am. J. Dis. Child. 1987; 141: 789–95.
DOI:10.1001/archpedi.1987.04460070091033
- Calzolari E., Garani G., Cocchi G., Magnani C., Rivieri F.,
Neville A. et al. Congenital heart defects: 15 years of experience
of the Emilia-Romagna Registry (Italy). Eur.
J. Epidemiol. 2003; 18: 773–80.
DOI: 10.1023/a:1025312603880
- Eskedal L., Hagemo P., Eskild A., Aamodt G., Seiler K.S.,
Thaulow E. A population-based study of extra-cardiac
anomalies in children with congenital cardiac malformations.
Cardiol. Young. 2004; 14: 600–7.
DOI: 10.1017/s1047951104006043
- Dilber D., Malcić I. Sprectrum of congenital heart defects in
Croatia. Eur. J. Pediatr. 2010; 169: 543–50.
DOI: 10.1007/s00431-009-1064-3
- Lodha R., Kabra S.K., Pan R.M. Antibiotics for community-acquired
pneumonia in children. Cochrane Database of Systematic
Reviews. 2013.
DOI: 10.1002/14651858.cd004874.pub4
- Gardiner S., Gavranich J.B., Chang B. Antibiotics for community-
acquired lower respiratory tract infections secondary to
Mycoplasma pneumoniae in children. Cochrane Database
of Systematic Reviews. 2015.
DOI: 10.1002/14651858.cd004875.pub5
About the authors
- Gul’zhan I. Sarsenbaeva, Cand. Med. Sc., Cardiac Surgeon, Deputy Director,
orcid.org/0000-0002-7512-3991;
- Aleksey I. Kim, Dr Med. Sc., Professor, Chief of Department, orcid.org/0000-0002-1759-9895;
- Shamshagul’ T. Nauryzalieva, Cand. Med. Sc., Pulmonologist, Head of Department
