medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-35-7-10medalphabet-4764Research ArticleСтатьиКоронарное шунтирование и механическая поддержка кровообращения при проникающем ранении сердца: клинический случайCoronary artery bypass grafting and mechanical circulatory support in penetrating cardiac injury: a clinical caseЧибисовН. С.ChibisovN. S.

Чибисов Никита Сергеевич, врач анестезиолог-реаниматолог

Chibisov Nikita S., anesthesiologist and Intensive Care specialist

chibisovns@gmail.comВласенкоА. В.VlasenkoA. V.

Власенко Алексей Викторович, зав. отделением анестезиологии-реанимации № 32

Vlasenko Alexey V., head of Anesthesiology and Intensive Care Dept No. 32

ГлушенкоИ. А.GlushenkoI. A.

Глушенко Игорь Анатольевич, зав. отделением кардиохирургии № 40

Glushenko Igor A., head of Cardiac Surgery Dept No. 40

ЖежукП. А.ZhezhukP. A.

Жежук Павел Александрович, врач анестезиолог-реаниматолог

Zhezhuk Pavel A., anesthesiologist and Intensive Care specialist

ЛевиковД. И.LevikovD. I.

Левиков Дмитрий Ильич, зав. отделением анестезиологии-реанимации № 52

Levikov Dmitry I., head of Anesthesiology and Intensive Care Dept No. 52

КомароваА. Г.KomarovaA. G.

Комарова Анна Григорьевна, зам. главного врача по регионарному сосудистому центру

Komarova Anna G., deputy chief physician for the Regional Vascular Center

РодионовЕ. П.RodionovE. P.

Родионов Евгений Петрович, зам. главного врача по анестезиологииреанимации

Rodionov Evgeny P., deputy chief physician for Anesthesiology and Intensive Care

ГБУЗ «Московский многопрофильный научно-клинический центр им. С.П. Боткина ДЗМ»РоссияBotkin HospitalRussian Federation202525122025035Кардиология. Неотложная медицина (4)710Copyright © Чибисов Н.С., Власенко А.В., Глушенко И.А., Жежук П.А., Левиков Д.И., Комарова А.Г., Родионов Е.П., 20252025Чибисов Н.С., Власенко А.В., Глушенко И.А., Жежук П.А., Левиков Д.И., Комарова А.Г., Родионов Е.П.Chibisov N.S., Vlasenko A.V., Glushenko I.A., Zhezhuk P.A., Levikov D.I., Komarova A.G., Rodionov E.P.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/4764

Цель: клинический случай применения веноартериальной экстракорпоральной мембранной оксигенации (ВА-ЭКМО) при сочетании проникающего ранения сердца, инфаркта миокарда и экстренного аортокоронарного шунтирования (АКШ).Материалы и методы. Пациент 37 лет с проникающим ножевым ранением передней грудной стенки, осложненным гемоперикардом, кардиогенным шоком и острым инфарктом миокарда. На фоне сохраняющейся нестабильной системной гемодинамики после первичного хирургического вмешательства была инициирована периферическая ВА-ЭКМО, после чего выполнено экстренное АКШ.Результаты. Применение ВА-ЭКМО позволило стабилизировать гемодинамику и создать оптимальные условия для последующего шунтирования без пережатия аорты. После 72 ч механической поддержки кровообращения достигнута положительная динамика с восстановлением фракции выброса левого желудочка (ФВ ЛЖ) до 52% к моменту выписки.Заключение. Представленное наблюдение демонстрирует потенциальную эффективность ВА-ЭКМО как элемента комплексной терапии у пациентов с сочетанным поражением сердца. Ведущую роль в достижении положительного исхода сыграл мультидисциплинарный подход.

Objective. To describe a clinical case of venoarterial extracorporeal membrane oxygenation (VA-ECMO) used in a patient with a combination of penetrating cardiac injury, myocardial infarction, and emergency coronary artery bypass grafting (CABG).Materials and methods. A 37-year-old male patient with a stab wound to the anterior chest wall complicated by hemopericardium, cardiogenic shock, and acute myocardial infarction is presented. Due to persistent systemic hemodynamic instability following initial surgical intervention, peripheral VA-ECMO was initiated, followed by emergency CABG.Results. The use of VA-ECMO allowed hemodynamic stabilization and created optimal conditions for subsequent bypass surgery without aortic crossclamping. After 72 hours of support, positive dynamics were achieved, with recovery of left ventricular ejection fraction to 52% by the time of discharge.Conclusion. This case demonstrates the potential effectiveness of VA-ECMO as a component of complex therapy in patients with combined cardiac injury. A multidisciplinary approach played a key role in achieving a favorable outcome.

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