medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-18-33-39medalphabet-4535Research ArticleСтатьиВозможности диагностики и профилактики развития интраоперационной гипотензииPossibilities of diagnostics and prevention of intraoperative hypotension developmenthttps://orcid.org/0000-0002-4388-6601АндреенковВ. С.AndreenkovV.  S.

Андреенков Вячеслав Сергеевич, врач анестезиолог-реаниматолог отделения анестезиологии-реанимации № 792

Москва

Andreenkov Vyacheslav S., anesthesiologist-resuscitator at Anesthesiology Resuscitation Dept No. 792

Moscow

reanimatology@outlook.comhttps://orcid.org/0000-0003-4535-2563ВласенкоА. В.VlasenkoA. V.

Власенко Алексей Викторович, д.м.н., профессор, заведующий кафедрой анестезиологии, реаниматологии и неотложной медицины; заведующий отделением анестезиологии-реанимации № 322

Москва

Vlasenko Aleksey V., DM Sci (habil.), professor, head of Dept of Anesthesiology, Resuscitation and Emergency Medicine; head of Anesthesiology-Resuscitation Dept No. 322

Moscow

dr.vlasenko67@mail.ruКорниенкоА. Н.KornienkoA. N.

Корниенко Андрей Николаевич, д.м.н., заведующий отделением анестезиологии-реанимации № 792

Москва

Kornienko Andrey N., DM Sci (habil.), head of Anesthesiology-Resuscitation Dept No. 792

Moscow

ankornienk@ya.ruhttps://orcid.org/0000-0003-4511-5998КолонтаревК. Б.KolontarevK. B.

Колонтарев Константин Борисович, д.м.н., профессор, заместитель руководителя

Москва

Kolontarev Konstantin B., DM Sci (habil.), professor, deputy head

Moscow

kb80@yandex.ruhttps://orcid.org/0000-0002-3852-8877РодионовЕ. П.RodionovE. P.

Родионов Евгений Петрович, к.м.н., Заслуженный врач РФ, доцент кафедры анестезиологии, реаниматологии и неотложной медицины; заместитель главного врача по анестезиологии-реанимации

Москва

Rodionov Evgeny P., PhD Med, Honored Doctor of the Russian Federation, associate professor at Dept of Anesthesiology, Resuscitation and Emergency Medicine; deputy chief physician for Anesthesiology and Resuscitation

Moscow

dr.rodionov@gmail.comhttps://orcid.org/0009-0008-2271-1627КазаковА. С.KazakovA. S.

Казаков Андрей Сергеевич, к.м.н., врач анестезиолог-реаниматолог отделения анестезиологии-реанимации № 232

Москва

Kazakov Andrey S., PhD Med, anesthesiologist-resuscitator at Anesthesiology and Resuscitation Dept No. 232

Moscow

anesteziolog@icloud.comЕвдокимовЕ. А.EvdokimovE.  A.

Евдокимов Евгений Александрович, д.м.н. профессор, Заслуженный врач РФ, Почетный заведующий кафедрой, профессор кафедры

Москва

Evdokimov Evgeny A., DM Sci (habil.), professor, Honored Doctor of the Russian Federation, Honorary Head of Dept, professor at Dept

Moscow

ea_evdokimov@mail.ruМаковейВ.  И.MakoveyV. I.

Маковей Виктория Ивановна, к.м.н., доцент, заведующая учебной частью кафедры

Москва

Makovey Victoria I., PhD Med, associate professor, head of Educational Dept

Moscow

Центр анестезиологии и реанимации, Московский урологический центр ГБУЗ города Москвы «Московский многопрофильный научно-клинический центр имени С.П. Боткина» Департамента здравоохранения города МосквыРоссияMoscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin (Botkin hospital)Russian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; Центр анестезиологии и реанимации, Московский урологический центр ГБУЗ города Москвы «Московский многопрофильный научно-клинический центр имени С.П. Боткина» Департамента здравоохранения города МосквыРоссияRussian Medical Academy for Continuing Professional Education; Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin (Botkin hospital)Russian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian Federation202501092025018Кардиология. Неотложная медицина (2)3339Copyright © Андреенков В.С., Власенко А.В., Корниенко А.Н., Колонтарев К.Б., Родионов Е.П., Казаков А.С., Евдокимов Е.А., Маковей В.И., 20252025Андреенков В.С., Власенко А.В., Корниенко А.Н., Колонтарев К.Б., Родионов Е.П., Казаков А.С., Евдокимов Е.А., Маковей В.И.Andreenkov V.S., Vlasenko A.V., Kornienko A.N., Kolontarev K.B., Rodionov E.P., Kazakov A.S., Evdokimov E. ., Makovey V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4535

Интраоперационная гипотензия – это клиническая проблема, суть которой заключается в снижении артериального давления во время хирургических операций, приводящему к различным осложнениям в интра- и постоперационном периоде (острое почечное повреждение, послеоперационный делирий, инсульт и инфаркт миокарда). Согласно данным ряда исследований, интраоперационная гипотензия связана с повышением госпитальной летальности у любых оперированных больных, чем обусловлена практическая значимость изучения этого патологического состояния. Поэтому вопросы, касающиеся изучения механизмов патогенеза, способов прогнозирования и профилактики интраоперационной гипотензии, остаются предметом актуального научного поиска. Так, ряд исследований направлен на определение индивидуальных показателей нормального артериального давления, однако эта проблема требует дальнейшего изучения. Патофизиология этого состояния также является предметом для исследований. Известно, что вовремя индукции анестезии самой частой причиной гипотензии является побочное действие лекарственных средств, а во время основного этапа операции – кровопотеря. В обоих случаях ведущим патогенетическим механизмом гипотензии является недостаточность адаптации сердечно-сосудистой системы пациента к изменениям кардиогемодинамики. Учитывая гетерогенность предоперационного состояния сердечно-сосудистой системы у разных пациентов и крайне разнообразный формат хирургических вмешательств, ключевое значение приобретает персонифицированный подход к прогнозированию, профилактике и коррекции интраоперационной гипотензии. Гиповолемия является одним из основных патофизиологических факторов интраоперационной гипотензии, в связи с чем коррекция волемического статуса рассматривается как метод профилактики снижения артериального давления во время операции. В рамках персонифицированного подхода разработаны алгоритмы профилактики интраоперационной гипотензии, основанные на инструментах предоперационной оценки волемического статуса пациента. Некоторые из этих алгоритмов приведены в обзоре.

Intraoperative hypotension is a clinical problem, the essence of which is a decrease in blood pressure during surgical procedures, leading to various complications in the intra- and postoperative period (acute kidney injury, postoperative delirium, stroke, and myocardial infarction). According to a number of studies, intraoperative hypotension is associated with increased hospital mortality in any operated patients, which explains the practical significance of this pathologic condition. Therefore, the issues related to the study of pathogenesis mechanisms, methods of prediction and prevention of intraoperative hypotension remain the subject of actual scientific search. For example, a number of studies are aimed at individual normal blood pressure determination, but this problem still unsolved. The pathophysiology of this condition is also a subject for study. It is known that during induction of anesthesia, the most common cause of hypotension is the side effects of drugs, and during the main stage of surgery it is blood loss. In both cases, the leading pathogenetic mechanism of hypotension is the insufficiency of the patient’s cardiovascular system to the onset of hemodynamic changes. Taking into account the heterogeneity of the cardiovascular system’s preoperative state in different patients and the extremely diverse format of surgical interventions, a personalized approach to the prediction, prevention and correction of intraoperative hypotension becomes of key importance. In recent years, the prediction and prevention of hypotension has become a subject of scientific interest. Hypovolemia is one of the main intraoperative hypotension’s pathophysiologic factors. Therefore, correction of volemic status is considered as a perioperative pressure reduction prevention method. As part of the personalized approach, the intraoperative hypotension prevention algorithms are used. These algorithms are based on the preoperative assessment of the patient’s volemic status using different instrumental tools. Some of such algorithms are summarized in the review.

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